Stepwise intensive rehabilitation can effectively improve the pulmonary and diaphragmatic functioning of persons with serious chronic obstructive pulmonary disease
10.3760/cma.j.cn421666-20240227-00146
- VernacularTitle:基于信息化的阶梯式重症康复治疗对慢性阻塞性肺疾病急性加重期患者的影响
- Author:
Yanping FU
1
;
Jinzhu WANG
;
Shuyan LI
;
Juanhong CHEN
;
Lingzhi JIANG
;
Huiping YAO
;
Xiangming YE
Author Information
1. 浙江省人民医院（附属人民医院）重症康复病区，杭州医学院，杭州 310014
- Keywords:
Chronic obstructive pulmonary disease;
Intensive care rehabilitation;
Stepwise rehabilitation
- From:
Chinese Journal of Physical Medicine and Rehabilitation
2024;46(11):1004-1010
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To document the impact of information-based, stepwise, intensive rehabilitation therapy on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:Eighty such patients in an intensive care unit (ICU) were randomly divided into a control group and an observation group, each of 40. The control group received routine ICU rehabilitation, while the observation group underwent information-based, step-wise ICU rehabilitation. Upon admission to and discharge from the ICU, the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, and diaphragm functioning were compared between the two groups. The duration of mechanical ventilation, the incidence of ventilator-associated pneumonia (VAP), length of stay in the ICU, incidence of delirium, and the incidence of deep vein thrombosis (DVT) were also recorded. The number of patients readmitted to the ICU after discharge, and the 28-day hospital mortality rate were recorded as well.Results:Significant improvement was observed in both groups in terms of their lung and diaphragm functioning, as well as in the rehabilitation- and hospital-related indicators. At discharge, significantly greater improvements were observed in the observation group compared with the control group in terms of their average FEV1, FVC, FEV1/FVC, inspiratory and expiratory diaphragm thickness, and diaphragm thickening rate. The average duration of mechanical ventilation and of rehabilitation interruptions was significantly less in the observation group. And incidents of accidental extubation, VAP, delirium and DVT were significantly fewer in the observation group as well. Their ICU stays tended to be significantly shorter without any significant difference between the two groups in the 28-day hospital mortality rate. The control group spent significantly less time in their daily rehabilitation sessions, with the result that significantly fewer of them achieved a grading of 2 or better on the mMRC respiratory questionnaire.Conclusion:Information-based stepwise intensive rehabilitation treatment can effectively improve the pulmonary and diaphragmatic function of AECOPD patients admitted to an ICU, shorten their mechanical ventilation time and the length of their ICU stay, and lower their incidence of VAP and DVT during hospitalization.
