Application of Lung Ultrasound-guided Pulmonary Rehabilitation Training in Patients with Mechanical Ventilation in ICU_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

XIONG Houren ¹ , ZHU Minghua ¹ , FANG Ming ¹ , HE Ting ² , XUE Yang ² ,  XU Gongxia ¹

1. Intensive Care Unit, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R.China;
2. Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China;

Corresponding?author：

XU Gongxia, Email: 3320805624@qq.com

Keywords：

Intensive Care Unit; Mechanical Ventilation; Pulmonary Rehabilitation; Lung Ultrasound; Nursing

DOI：

10.7507/1671-6205.202404024

Video：

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Objective To explore the effectiveness of lung ultrasound-guided pulmonary rehabilitation training in ICU patients on mechanical ventilation.Methods Patients on mechanical ventilation admitted to the ICU of a tertiary A-level hospital in Hefei city from July 2022 to December 2023 were selected and randomly divided into a control group and an experimental group using a random number table method. The control group received conventional pulmonary rehabilitation training, while the experimental group underwent lung ultrasound-guided pulmonary rehabilitation training. The differences in lung ultrasound scores, oxygenation index, diaphragm function, weaning success rate, and mechanical ventilation time were compared between the two groups on the 1st, 3rd, 5th, and 7th days of intervention.Results The study was completed with 48 cases in the experimental group and 46 cases in the control group. Repeated measures ANOVA showed statistically significant intergroup effects, time effects, and interaction effects on lung ultrasound scores, oxygenation index, diaphragm mobility, and diaphragm thickness variability rate (P<0.05). The weaning success rate was higher in the experimental group than in the control group, and the mechanical ventilation time was shorter, with statistically significant differences (P<0.05).Conclusions The lung ultrasound-guided pulmonary rehabilitation training program can effectively improve the pulmonary status, oxygenation, and diaphragm function of ICU patients on mechanical ventilation, increase the success rate of weaning, shorten the mechanical ventilation time, and accelerate patient recovery.

Citation： XIONG Houren, ZHU Minghua, FANG Ming, HE Ting, XUE Yang, XU Gongxia. Application of Lung Ultrasound-guided Pulmonary Rehabilitation Training in Patients with Mechanical Ventilation in ICU. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(9): 634-639. doi: 10.7507/1671-6205.202404024 Copy

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2.	Huang HY, Huang CY, Li LF. Prolonged Mechanical Ventilation: Outcomes and Management. J Clin Med, 2022, 11(9): 2451.
3.	Rochester CL, Alison JA, Carlin B, et al. Pulmonary rehabilitation for adults with chronic respiratory disease: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med, 2023, 208(4): e7-e26.
4.	Tong ZH, Chen YS, Jiang HY. [Annual progress in pulmonary rehabilitation 2023]. Zhonghua Jie He He Hu Xi Za Zhi, 2024, 47(1): 49-54.
5.	Demi L, Wolfram F, Klersy C, et al. New International Guidelines and Consensus on the Use of Lung Ultrasound. J Ultrasound Med, 2023, 42(2): 309-344.
6.	曹嵐, 張麗娜, 王小亭, 等. 重癥護理超聲專家共識. 中華現代護理雜志, 2020, 26(33): 4577-4590.
7.	中華醫學會災難醫學分會, 中國醫師協會急救復蘇與災難醫學分會, 中國醫學救援協會救援防護分會. ARDS患者肺康復訓練專家共識. 中國急救復蘇與災害醫學雜志, 2022, 17(4): 421-426.
8.	中華醫學會呼吸病學分會, 中國老年保健醫學研究會呼吸病學分會, 中國呼吸醫師分會呼吸職業發展委員會呼吸治療師工作組, 等. 機械氣道廓清技術臨床應用專家共識. 中華結核和呼吸雜志, 2023, 46(9): 866-879.
9.	Szabó M, Bozó A, Darvas K, et al. The role of ultrasonographic lung aeration score in the prediction of postoperative pulmonary complications: an observational study. BMC Anesthesiol, 2021, 21(1): 19.
10.	Yang Y, Zhang RJ, Yuan XN, et al. Clinical effect of pulmonary rehabilitation in patients with mechanical ventilation: A meta-analysis. Int J Artif Organs, 2024, 47(2): 96-106.
11.	全殷殷. 超聲引導下的胸部物理治療在中重度ARDS患者俯臥位通氣中的應用研究. 浙江中醫藥大學, 2023.
12.	Hansell L, Milross M, Delaney A, et al. Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: a systematic review. J Physiother, 2021, 67(1): 41-48.
13.	Li C, Ren Q, Li X, et al. Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial. BMC Anesthesiol, 2022, 22(1): 215.
14.	Liu T, Huang J, Wang X, et al. Effect of recruitment manoeuvres under lung ultrasound-guidance and positive end-expiratory pressure on postoperative atelectasis and hypoxemia in major open upper abdominal surgery: A randomized controlled trial. Heliyon, 2023, 9(2): e13348.
15.	Lan L, Ni Y, Zhou Y, et al. PEEP-Induced Lung Recruitment Maneuver Combined with Prone Position for ARDS: A Single-Center, Prospective, Randomized Clinical Trial. J Clin Med, 2024, 13(3): 853.
16.	Blok SG, Mousa A, Brouwer MG, et al. Effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients (CONFIDENCE): protocol for a multicentre randomised controlled trial. Trials, 2023, 24(1): 226.
17.	Huang HP, Chen KH, Tsai CL, et al. Effects of High-Frequency Chest Wall Oscillation on Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Chron Obstruct Pulmon Dis. 2022 Nov 10;17: 2857-2869.
18.	Zhang J, Feng J, Jia , et al. Research progress on the pathogenesis and treatment of ventilator-induced diaphragm dysfunction. Heliyon. 2023, 9(11): e22317.
19.	Bao Q, Chen L, Chen X, et al. The effects of external diaphragmatic pacing on diaphragm function and weaning outcomes of critically ill patients with mechanical ventilation: a prospective randomized study. Ann Transl Med, 2022, 10(20): 1100.
20.	Shi ZH, Zhou JX, HEUNKS L. Diaphragm-Protective Mechanical Ventilation: Saving the Diaphragm from the Detrimental Effects of Mechanical Ventilation. J Translational Criti Care Med, 2022, 4(1): 5.
21.	Mawla TSA, Fattah SRA, Halim AMA, et al. Diaphragmatic Function Assessment Using Chest Ultrasonography as a Predictor for Weaning from Mechanical Ventilation. The Egyptian Journal of Critical Care Medicine, 2022, 9(1): p 1-9.

1. Perkins GD, Mistry D, Gates S, et al. Effect of protocolized weaning with early extubation to noninvasive ventilation vs invasive weaning on time to liberation from mechanical ventilation among patients with respiratory failure: the breathe randomized clinical trial. JAMA, 2018, 320(18): 1881-1888.
2. Huang HY, Huang CY, Li LF. Prolonged Mechanical Ventilation: Outcomes and Management. J Clin Med, 2022, 11(9): 2451.
3. Rochester CL, Alison JA, Carlin B, et al. Pulmonary rehabilitation for adults with chronic respiratory disease: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med, 2023, 208(4): e7-e26.
4. Tong ZH, Chen YS, Jiang HY. [Annual progress in pulmonary rehabilitation 2023]. Zhonghua Jie He He Hu Xi Za Zhi, 2024, 47(1): 49-54.
5. Demi L, Wolfram F, Klersy C, et al. New International Guidelines and Consensus on the Use of Lung Ultrasound. J Ultrasound Med, 2023, 42(2): 309-344.
6. 曹嵐, 張麗娜, 王小亭, 等. 重癥護理超聲專家共識. 中華現代護理雜志, 2020, 26(33): 4577-4590.
7. 中華醫學會災難醫學分會, 中國醫師協會急救復蘇與災難醫學分會, 中國醫學救援協會救援防護分會. ARDS患者肺康復訓練專家共識. 中國急救復蘇與災害醫學雜志, 2022, 17(4): 421-426.
8. 中華醫學會呼吸病學分會, 中國老年保健醫學研究會呼吸病學分會, 中國呼吸醫師分會呼吸職業發展委員會呼吸治療師工作組, 等. 機械氣道廓清技術臨床應用專家共識. 中華結核和呼吸雜志, 2023, 46(9): 866-879.
9. Szabó M, Bozó A, Darvas K, et al. The role of ultrasonographic lung aeration score in the prediction of postoperative pulmonary complications: an observational study. BMC Anesthesiol, 2021, 21(1): 19.
10. Yang Y, Zhang RJ, Yuan XN, et al. Clinical effect of pulmonary rehabilitation in patients with mechanical ventilation: A meta-analysis. Int J Artif Organs, 2024, 47(2): 96-106.
11. 全殷殷. 超聲引導下的胸部物理治療在中重度ARDS患者俯臥位通氣中的應用研究. 浙江中醫藥大學, 2023.
12. Hansell L, Milross M, Delaney A, et al. Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: a systematic review. J Physiother, 2021, 67(1): 41-48.
13. Li C, Ren Q, Li X, et al. Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial. BMC Anesthesiol, 2022, 22(1): 215.
14. Liu T, Huang J, Wang X, et al. Effect of recruitment manoeuvres under lung ultrasound-guidance and positive end-expiratory pressure on postoperative atelectasis and hypoxemia in major open upper abdominal surgery: A randomized controlled trial. Heliyon, 2023, 9(2): e13348.
15. Lan L, Ni Y, Zhou Y, et al. PEEP-Induced Lung Recruitment Maneuver Combined with Prone Position for ARDS: A Single-Center, Prospective, Randomized Clinical Trial. J Clin Med, 2024, 13(3): 853.
16. Blok SG, Mousa A, Brouwer MG, et al. Effect of lung ultrasound-guided fluid deresuscitation on duration of ventilation in intensive care unit patients (CONFIDENCE): protocol for a multicentre randomised controlled trial. Trials, 2023, 24(1): 226.
17. Huang HP, Chen KH, Tsai CL, et al. Effects of High-Frequency Chest Wall Oscillation on Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Chron Obstruct Pulmon Dis. 2022 Nov 10;17: 2857-2869.
18. Zhang J, Feng J, Jia , et al. Research progress on the pathogenesis and treatment of ventilator-induced diaphragm dysfunction. Heliyon. 2023, 9(11): e22317.
19. Bao Q, Chen L, Chen X, et al. The effects of external diaphragmatic pacing on diaphragm function and weaning outcomes of critically ill patients with mechanical ventilation: a prospective randomized study. Ann Transl Med, 2022, 10(20): 1100.
20. Shi ZH, Zhou JX, HEUNKS L. Diaphragm-Protective Mechanical Ventilation: Saving the Diaphragm from the Detrimental Effects of Mechanical Ventilation. J Translational Criti Care Med, 2022, 4(1): 5.
21. Mawla TSA, Fattah SRA, Halim AMA, et al. Diaphragmatic Function Assessment Using Chest Ultrasonography as a Predictor for Weaning from Mechanical Ventilation. The Egyptian Journal of Critical Care Medicine, 2022, 9(1): p 1-9.

Chinese Journal of Respiratory and Critical Care Medicine

Application of Lung Ultrasound-guided Pulmonary Rehabilitation Training in Patients with Mechanical Ventilation in ICU

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