Effects of early rehabilitation therapy on patients with mechanical ventilation

doi:10.5847/wjem.j.issn.1920-8642.2014.01.008

Abstract

Abstract:

BACKGROUND: For patients in intensive care unit (ICU), mechanical ventilation is an effective treatment to survive from acute illness and improve survival rates. However, long periods of bed rest and restricted physical activity can result in side effects. This study aimed to investigate the feasibility of early rehabilitation therapy in patients with mechanical ventilation.
METHODS: A randomized controlled trial was carried out. Sixty patients, with tracheal intubation or tracheostomy more than 48 hours and less than 72 hours, were admitted to the ICU of the Affiliated Hospital of Medical College, Qingdao University, from May 2010 to May 2012. These patients were randomly divided into a rehabilitation group and a control group. In the rehabilitation group, rehabilitation therapy was performed twice daily, and the training time and intensity were adjusted according to the condition of the patients. Early rehabilitation therapy included heading up actively, transferring from the supine position to sitting position, sitting at the edge of the bed, sitting in chair, transferring from sitting to standing, and ambulating bedside. The patient's body mass index, days to first out of bed, duration of mechanical ventilation, length of ICU stay, APACHE II score, highest FiO₂, lowest PaO₂/FiO₂ and hospital mortality of patients were all compared between the rehabilitation group and the control group. The differences between the two groups were compared using Student's t test.
RESULTS: There was no significant difference in body mass index, APACHE II score, highest FiO₂, lowest PaO₂/FiO₂ and hospital mortality between the rehabilitation group and the control group (P>0.05). Patients in the rehabilitation group had shorter days to first out of bed (3.8±1.2 d vs. 7.3±2.8 d; P=0.00), duration of mechanical ventilation (5.6±2.1 d vs. 12.7±4.1 d; P=0.005) and length of ICU stay (12.7±4.1 d vs. 15.2±4.5 d; P=0.01) compared with the control group.
CONCLUSION: Early rehabilitation therapy was feasible and effective in improving the outcomes of patients with mechanical ventilation.

Key words: Early rehabilitation therapy, Mechanical ventilation, Intensive care unit, Hospital mortality, APACHE II score

Ze-hua Dong, Bang-xu Yu, Yun-bo Sun, Wei Fang, Lei Li. Effects of early rehabilitation therapy on patients with mechanical ventilation[J]. World Journal of Emergency Medicine, 2014, 5(1): 48-52.

Figures/Tables 2

References 31

1	Allen C, Glasziou P, Del MC. Bed rest: A potentially harmful treatment needing more careful evaluation. Lancet 1999; 354:1229-1233. doi: 10.1016/s0140-6736(98)10063-6 pmid: 10520630
2	Becher RD, Hoth JJ, Rebo JJ, Kendall JL, Miller PR. Locally derived versus guideline-based approach to treatment of hospital-acquired pneumonia in the trauma intensive care unit. Surg Infect (Larchmt) 2012; 13:352-359.
3	Bruunsgaard H. Physical activity and modulation of systemic low-level inflammation. J Leukoc Biol 2005; 78:819-835.
4	Convertino VA, Bloomfield SA, Greenleaf JE. An overview of the issues: physiological effects of bed rest and restricted physical activity. Med Sci Sports Exerc 1997; 29:187-190. doi: 10.1097/00005768-199702000-00004 pmid: 9044221
5	Zanni JM, Korupolu R, Fan E, Pradhan P, Janjua K, Palmer JB, et al. Rehabilitation therapy and outcomes in acute respiratory failure: An observational pilot project. J Crit Care 2010; 25:254-262. doi: 10.1016/j.jcrc.2009.10.010 pmid: 19942399
6	Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated ,critically ill patients: a randomised controlled trial. Lancet 2009; 373:1874-1882. doi: 10.1016/S0140-6736(09)60658-9 pmid: 19446324
7	Needham DM. Mobilizing patients in the intensive care unit improving neuromuscular weakness and physical function. JAMA 2008; 300:1685-1690. doi: 10.1001/jama.300.14.1685 pmid: 18840842
8	Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008; 36:2238-2243. doi: 10.1097/CCM.0b013e318180b90e pmid: 18596631
9	Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med 2007; 35:139-145. doi: 10.1097/01.CCM.0000251130.69568.87 pmid: 17133183
10	Wu XY, Huang YZ, Liu HG, Huang DY, Tang R, Qiu HB. Effects of pulmonary stretch reflex on lung injury in rabbits with acute respiratory distress syndrome. World J Emerg Med 2011; 2:296-301. doi: 10.5847/wjem.j.1920-8642.2011.04.010 pmid: 25215027
11	Hodgin KE, Nordon-Craft A, McFann KK, Mealer ML, Moss M. Physical therapy utilization in intensive care units: Results from a national survey. Crit Care Med 2009; 37:561-567. doi: 10.1097/CCM.0b013e3181957449 pmid: 19114903
12	Shen M. Updated guidelines from pulmonary rehabilitation to see the progress of the study of pulmonary rehabilitation. Chin J Tuberc Respir Dis 2010; 33:216-218.
13	Zhang JG, Chen XJ, Liu F, Zeng ZG, Qian KJ. Lung recruitment maneuver effects on respiratory mechanics and extravascular lung water index in patients with acute respiratory distress syndrome. World J Emerg Med 2011; 2:201-205. doi: 10.5847/wjem.j.1920-8642.2011.03.008 pmid: 25215010
14	Hough CL. Neuromuscular sequelae in survivors of acute lung injury. Clin Chest Med 2006; 27:691-703. doi: 10.1016/j.ccm.2006.07.002
15	Maramattom BV, Wijdicks EF. Acute neuromuscular weakness in the intensive care unit. Crit Care Med 2006; 34: 2835-2841. pmid: 16932235
16	Ciesla DJ, Moore EE, Johnson JL, Cothren CC, Banerjee A, Burch JM, et al. Decreased progression of postinjury lung dysfunction to the acute respiratory distress syndrome and multiple organ failure. Surgery 2006; 140:640-647. Epub 2006 Aug 30. doi: 10.1016/j.surg.2006.06.015 pmid: 17011912
17	Morin AM, Zähringer J, Kasper M, von Schmädel E, Suhayda A. Acute respiratory insufficiency after inhaling concrete dust—a case report. Anasthesiol Intensivmed Notfallmed Schmerzther 1997; 32:56-60. doi: 10.1055/s-2007-995011
18	Tellez PA, Pronovost PJ, Needham DM. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 2007; 33:1876-1891. doi: 10.1007/s00134-007-0772-2 pmid: 17639340
19	Hermans G, Wilmer A, Meersseman W, Milants I, Wouters PJ, Bobbaers H, et al. Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. 2007; 175:480-489. Epub 2006 Nov 30
20	Larsson L, Li X, Edström L, Eriksson LI, Zackrisson H, Argentini C, et al. Acute quadriplegia and loss of muscle myosin in patients treated with nondepolarizing neuromuscular blocking agents and corticosteroids: mechanisms at the cellular and molecular levels. Crit Care Med 2000; 28:34-45. doi: 10.1097/00003246-200001000-00006 pmid: 10667496
21	De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 2002; 288:2859-2867. pmid: 12472328
22	Chu YF, Jiang Y, Meng M, Jiang JJ, Zhang JC, Ren HS, et al. Incidence and risk factors of gastrointestinal bleeding in mechanically ventilated patients. World J Emerg Med 2010; 1:32-36. pmid: 25214937
23	Orme J Jr, Romney JS, Hopkins RO, Pope D, Chan KJ, Thomsen G, et al. Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 2003; 167:690-694. doi: 10.1164/rccm.200206-542OC pmid: 12493646
24	Curtis JR. The long-term outcomes of mechanical ventilation: What are they and how should they be used? Respir Care 2002; 47:496-505. pmid: 11929620
25	Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ. Sedation in the intensive care unit: a systematic review. JAMA 2000; 283:1451-1459. doi: 10.1001/jama.283.11.1451 pmid: 10732935
26	Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G. The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest 1998; 114:541-548. doi: 10.1378/chest.114.2.541 pmid: 9726743
27	Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342:1471-1477. doi: 10.1056/NEJM200005183422002 pmid: 10816184
28	Huang H, Xu XH, Chen Y, Lu LX, Zhu CQ. Early tracheotomy for acute severe asthma. World J Emerg Med 2011; 2:154-156. pmid: 25215002
29	De Jonghe B, Bastuji-Garin S, Fangio P, Lacherade JC, Jabot J, Appéré-De-Vecchi C, et al. Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med 2005; 33:120-127. doi: 10.1097/01.ccm.0000150268.04228.68 pmid: 15644658
30	Schweickert WD, Gehlbach BK, Pohlman AS, Hall JB, Kress JP. Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med 2004; 32:1272-1276. pmid: 15187505
31	Martin UJ, Hincapie L, Nimchuk M, Gaughan J, Criner GJ. Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation. Crit Care Med 2005; 33:2259-2265. doi: 10.1097/01.ccm.0000181730.02238.9b pmid: 16215380

Variables	Rehabilitation group (n, %)	Control group (n, %)	P value
Abdominal infections	6 (0.2)	5 (0.17)	0.74
ARDS	9 (0.3)	10 (0.33)	0.78
Sepsis (non-pulmonary and peritoneal source)	2 (0.07)	2 (0.07)	0.60
Severe acute pancreatitis (without surgical treatment)	4 (0.13)	5 (0.17)	1.00
Community pneumonia	1 (0.03)	2 (0.07)	1.00
Aspiration pneumonia	6 (0.2)	5 (0.16)	0.74
COPD exacerbation	2 (0.07)	1 (0.03)	1.00

Variables	Rehabilitation group	Control group	P value
Age	55.3±16.1	55.5±16.2	0.48
Sex (male)	21	20	0.78
Body mass index	21.6±4.1	21.3±4.3	0.39
Days to first out of bed	3.8±1.2	14.9±4.7	0.00
Duration of mechanical ventilation (days)	5.6±2.1	7.3±2.8	0.005
Length of ICU stay	12.7±4.1	15.2±4.5	0.01
APACHE II score (to ICU)	15.0±4.2	16.0±4.1	0.18
APACHE II score (out of ICU)	10.0±3.1	10.0±3.2	0.50
Highest FiO₂	70%	70%	1.0
Lowest PaO₂/FiO₂	196	194	1.0
Hospital mortality	2 (6.7%)	3 (10%)	1.0

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