Effect of early rehabilitation therapy on complications and prognosis in mechanically ventilated elderly patients with severe pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 LI Daliang , HUANG Xuemin , CEN Shukun , MENG Zijie , YAN Haiyan , TAO Zhenfeng

Intensive Care Unit, Hezhou Guang Ji Hospital, Hezhou, Guangxi 542899, P. R. China;

Corresponding author：

LI Daliang, Email: lidaliang19771207@163.com

Keywords：

Early rehabilitation therapy; Elderly patients; Severe pneumonia; Mechanical ventilation

DOI：

10.7507/1671-6205.201707047

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Objective To explore the effect of early rehabilitation treatment on complications and prognosis of elderly patients with sever pneumonia undergoing mechanical ventilation. Methods The patients who meeting the inclusion criteria were randomly divided into an early rehabilitation group and a control group, with 35 cases in each group. On basis of same routine treatment, the early rehabilitation group was treated with early rehabilitation. The early rehabilitation methods included exercise therapy, electrical stimulation therapy, swallowing therapy, cough training and wheelchair-bed transfer training, etc. The patients received individual training methods according to their conditions. The difference of two groups were observed in the rates of ICU-acquired weakness (ICU-AW), ventilator-associate pneumonia (VAP), the incidence of delirium, the mechanical ventilation time, ICU-hospital time, total hospital time, 30-day hospital mortality, extubation fail rate and tracheotomy rate. Results Compare with the control group, the incidence of ICU-AW (14.28% vs. 37.14%), VAP (8.57% vs. 28.57%), and delirium (40.00% vs. 65.71%) in the early rehabilitation group were significantly reduced (all P<0.05). The duration of delirium [(3.50±1.31) dvs. (6.40±1.47) d], the ventilation time [(6.32±2.19) d vs. (9.40±4.43) d], ICU hospitalization time [(10.80±3.64) d vs. (15.31±3.85) d] and total hospitalization time [(22.52±7.56) d vs. (30.22±11.54) d] of the early rehabilitation group were significantly lower than the control group (all P<0.001). The tracheotomy rate and 30-day hospital mortality of the early rehabilitation group were significantly lower than the control group (25.71%vs. 51.42% and 28.57% vs. 54.28%, both P<0.05). There was no significant difference in extubation fail rate (5.71%vs. 11.42%, P>0.05). In the early rehabilitation group, there were no complications such as pipe prolapse, limb injury or serious arrhythmia. Conclusion Early rehabilitation can reduce the incidence of ICU-AW, VAP, delirium in elderly patients with severe pneumonia, help to shorten the mechanical ventilation time, ICU hospitalization time and total hospitalization time, reduce extubation failure rate and tracheotomy rate, so it is safe and effective, and worthy of being popularized and applied.

Citation： LI Daliang, HUANG Xuemin, CEN Shukun, MENG Zijie, YAN Haiyan, TAO Zhenfeng. Effect of early rehabilitation therapy on complications and prognosis in mechanically ventilated elderly patients with severe pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(1): 46-50. doi: 10.7507/1671-6205.201707047 Copy

1.	Hodgson CL, Berney S, Harrold M, et al. Clinical review: early patient mobilization in the ICU. Crit Care, 2013, 17(1): 207.
2.	Ntoumenopulos G. Rehabilitation during mechanical ventilation: review of the recent literature. Intensive Crit Care Nurs, 2015, 31(3): 125-132.
3.	American Thoracic Society. Guidelines for the management of adults with community acquired pneumonia. Am J Crit Care Med, 2001, 163(7): 1730-1754.
4.	American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care, 2005, 171(4): 388-416.
5.	Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med, 2008, 36(8): 2238-2243.
6.	Official Statement of the American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
7.	Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med, 2014, 371(3): 287-288.
8.	Patel SB, Poston JT, Pojlman A, et al. Rapidly reversible, sedation-related delirium versus persistent delirium in the intensive care unit. Am J Respir Crit Care Med, 2014, 189(6): 658-665.
9.	杨丽平, 张志刚, 张彩云, 等. 机械通气患者早期主动活动效果的Meta分析. 中国护理管理, 2017, 17(6): 758-764.
10.	Yosef-Brauner O, Adi N, Beb Shahar T, et al. Effect of physical therapy on muscle strength, respiratory muscles and functional parameters in patients with intensive care unit-acquired weakness. Clin Respir J, 2015, 9(1): 1-6.
11.	dos Santos LJ, de Aguiar Lemos F, Bianchi T, et al. Early rehabilitation using a passive cycle ergometer on muscle morphology in mechanically ventilated critically ill patients in the Intensive Care Unit (MoVe-ICU study): study protocol for a randomized controlled trial. Trials, 2015, 16: 383.
12.	Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med, 2008, 358(13): 1327-1335.
13.	Semmler A, Okulla T, Kaiser M, et al. Long-term neuromuscular sequelae of critical illness. J Neurol, 2013, 260(1) : 151-157.
14.	Gomez-Cabrera MC, Domenech E, Vina J. Moderate exercise is an antioxidant: upregulation of antioxidant genes by training. Free Radie Biol Med, 2008, 44(2): 126-131.
15.	Pipanmekaporn T, Chittawatanarat K, Chaiwat O, et al. Incidence and risk factors of delirium in multi-center Thai surgical intensive care units: a prospective cohort study. J Intensive Care, 2015, 3: 53.
16.	Zaal IJ, Devlin JW, Hazelbag M, et al. Benzodiazepine-associated delirium in critically ill adults. Intensive Care Med, 2015, 41(12): 2130-2137.
17.	陈小璐, 蒋莉. 运动疗法对认知功能影响机制的研究. 儿科药学杂志, 2010, 16(4): 63-64.
18.	Needham DM, Korupolu R, Zanni JM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement projec. Arch Phys Med Rehabil, 2010, 91(4): 536-542.
19.	何娟, 郑小妹, 吴楠, 等. 早期康复活动对重症监护病房呼吸衰竭患者康复的影响. 中国医药导报, 2016, 13(24): 185-188.
20.	Gruther W, Benesch T, Zorn C, et al. Muscle wasting in intensive care patients: ultrasound observation of the M. quadriceps femoris muscle layer. J Rehabil Med, 2008, 40(3): 185-189.
21.	刘贞, 孟素秋, 杨圣强, 等. 早期活动对慢性阻塞性肺疾病急性加重机械通气患者谵妄及呼吸力学影响的前瞻性研究. 中国呼吸与危重监护杂志, 2016, 15(4): 324-328.
22.	Schweichert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized trial. Lancet, 2009, 373(9678): 1874-1882.
23.	Pohlman MC, Schweichert WD, Pohlman AS, et al. Feasibility of physical and pccupational therapy beginning from initiation of mechanical ventilation. Crit Care Med, 2010, 8(11): 2089-2094.
24.	Mendez-Tellez PA, Needham DM. Early physical rehabilitation in ICU and ventilator liberation. Respir Care, 2012, 57(10): 1663-1669.
25.	Turner DA, Cheifetz IM, Rehder KJ, et al. Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach. Crit Care Med, 2011, 39(12): 2593-2598.

1. Hodgson CL, Berney S, Harrold M, et al. Clinical review: early patient mobilization in the ICU. Crit Care, 2013, 17(1): 207.
2. Ntoumenopulos G. Rehabilitation during mechanical ventilation: review of the recent literature. Intensive Crit Care Nurs, 2015, 31(3): 125-132.
3. American Thoracic Society. Guidelines for the management of adults with community acquired pneumonia. Am J Crit Care Med, 2001, 163(7): 1730-1754.
4. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care, 2005, 171(4): 388-416.
5. Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med, 2008, 36(8): 2238-2243.
6. Official Statement of the American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
7. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med, 2014, 371(3): 287-288.
8. Patel SB, Poston JT, Pojlman A, et al. Rapidly reversible, sedation-related delirium versus persistent delirium in the intensive care unit. Am J Respir Crit Care Med, 2014, 189(6): 658-665.
9. 杨丽平, 张志刚, 张彩云, 等. 机械通气患者早期主动活动效果的Meta分析. 中国护理管理, 2017, 17(6): 758-764.
10. Yosef-Brauner O, Adi N, Beb Shahar T, et al. Effect of physical therapy on muscle strength, respiratory muscles and functional parameters in patients with intensive care unit-acquired weakness. Clin Respir J, 2015, 9(1): 1-6.
11. dos Santos LJ, de Aguiar Lemos F, Bianchi T, et al. Early rehabilitation using a passive cycle ergometer on muscle morphology in mechanically ventilated critically ill patients in the Intensive Care Unit (MoVe-ICU study): study protocol for a randomized controlled trial. Trials, 2015, 16: 383.
12. Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med, 2008, 358(13): 1327-1335.
13. Semmler A, Okulla T, Kaiser M, et al. Long-term neuromuscular sequelae of critical illness. J Neurol, 2013, 260(1) : 151-157.
14. Gomez-Cabrera MC, Domenech E, Vina J. Moderate exercise is an antioxidant: upregulation of antioxidant genes by training. Free Radie Biol Med, 2008, 44(2): 126-131.
15. Pipanmekaporn T, Chittawatanarat K, Chaiwat O, et al. Incidence and risk factors of delirium in multi-center Thai surgical intensive care units: a prospective cohort study. J Intensive Care, 2015, 3: 53.
16. Zaal IJ, Devlin JW, Hazelbag M, et al. Benzodiazepine-associated delirium in critically ill adults. Intensive Care Med, 2015, 41(12): 2130-2137.
17. 陈小璐, 蒋莉. 运动疗法对认知功能影响机制的研究. 儿科药学杂志, 2010, 16(4): 63-64.
18. Needham DM, Korupolu R, Zanni JM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement projec. Arch Phys Med Rehabil, 2010, 91(4): 536-542.
19. 何娟, 郑小妹, 吴楠, 等. 早期康复活动对重症监护病房呼吸衰竭患者康复的影响. 中国医药导报, 2016, 13(24): 185-188.
20. Gruther W, Benesch T, Zorn C, et al. Muscle wasting in intensive care patients: ultrasound observation of the M. quadriceps femoris muscle layer. J Rehabil Med, 2008, 40(3): 185-189.
21. 刘贞, 孟素秋, 杨圣强, 等. 早期活动对慢性阻塞性肺疾病急性加重机械通气患者谵妄及呼吸力学影响的前瞻性研究. 中国呼吸与危重监护杂志, 2016, 15(4): 324-328.
22. Schweichert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized trial. Lancet, 2009, 373(9678): 1874-1882.
23. Pohlman MC, Schweichert WD, Pohlman AS, et al. Feasibility of physical and pccupational therapy beginning from initiation of mechanical ventilation. Crit Care Med, 2010, 8(11): 2089-2094.
24. Mendez-Tellez PA, Needham DM. Early physical rehabilitation in ICU and ventilator liberation. Respir Care, 2012, 57(10): 1663-1669.
25. Turner DA, Cheifetz IM, Rehder KJ, et al. Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach. Crit Care Med, 2011, 39(12): 2593-2598.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of early rehabilitation therapy on complications and prognosis in mechanically ventilated elderly patients with severe pneumonia

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