Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China.
Intensive Crit Care Nurs. 2024 Oct;84:103744. doi: 10.1016/j.iccn.2024.103744. Epub 2024 Jul 31.
To assess the efficacy of early rehabilitation program for VV-ECMO patients and observe the influence on the respiratory and skeletal muscles.
A cohort study.
The study was conducted with VVECMO patients in a comprehensive ICU with 32 beds.
Ultrasound measurements were performed on each patients on day 1, 4, 7, 10, and 14, including diaphragmatic excursion (DE), diaphragmatic thickening fraction (DTF), intercostal muscle thickening fraction (ICMTF), thickness of the rectus femoris (RF), thickness of vastus intermedius (VI), and rectus femoris cross-sectional area (RF-CSA). Data on basic characteristics, results of ultrasound measurements, patients outcomes and adverse events were collected.
22 patients received usual rehabilitation measures were set as the control group and 23 patients underwent early rehabilitation program were set as the study group. There were no differences in diaphragmatic excursion, diaphragmatic thickening fraction, intercostal muscle thickening fraction, thickness of rectus femoris, thickness of vastus intermedius, rectus femoris cross-sectional area between two groups on day 1 after VV-ECMO treatment (P > 0.05). The variation of diaphragmatic thickening fraction and intercostal muscle thickening fraction decreased on the day 7 and 14 after treatment (P < 0.05). The variation of vastus intermedius thickness and rectus femoris cross-sectional area in the study group was less compared with those in the control group on day 4, 7, 10 and 14. The ECMO duration in the study group was shorter than that in the control group (12.00 [10.00-16.25] days vs. 8.00 [6.00-12.25] days, P = 0.002), but there was no difference in the duration of mechanical ventilation.
Early rehabilitation program can ameliorate muscle atrophy. We recommend implementation of our rehabilitation program in VV-ECMO patients. This program can improve skeletal muscle atrophy and dysfunction in patients with VV-ECMO effectively and perhaps improve quality of life for patients in the future.
Early rehabilitation program put higher demands bedside nurses. It requires them to observe conditions of VVECMO patients closely, assess the feasibility of rehabilitation promptly, and monitor for any adverse reactions. Ultrasound measurement is a noninvasive and useful tool to assess muscle atrophy in ICU patients. Early rehabilitation program can improve skeletal muscle atrophy and dysfunction in patients with VV-ECMO effectively.
评估 VV-ECMO 患者早期康复方案的疗效，并观察其对呼吸肌和骨骼肌的影响。
队列研究。
该研究在一个拥有 32 张床位的综合 ICU 中对 VV-ECMO 患者进行。
对每位患者在第 1、4、7、10 和 14 天进行超声测量，包括膈肌活动度（DE）、膈肌增厚分数（DTF）、肋间肌增厚分数（ICMTF）、股直肌厚度（RF）、股中间肌厚度（VI）和股直肌横截面积（RF-CSA）。收集基本特征、超声测量结果、患者结局和不良事件的数据。
22 例接受常规康复措施的患者作为对照组，23 例接受早期康复方案的患者作为研究组。VV-ECMO 治疗后第 1 天两组患者的膈肌活动度、膈肌增厚分数、肋间肌增厚分数、股直肌厚度、股中间肌厚度、股直肌横截面积无差异（P>0.05）。治疗后第 7、14 天膈肌增厚分数和肋间肌增厚分数的变化均减少（P<0.05）。研究组股中间肌厚度和股直肌横截面积的变化在第 4、7、10 和 14 天均小于对照组。研究组 ECMO 持续时间短于对照组（12.00[10.00-16.25]天比 8.00[6.00-12.25]天，P=0.002），但机械通气时间无差异。
早期康复方案可改善肌肉萎缩。我们建议在 VV-ECMO 患者中实施我们的康复方案。该方案可有效改善 VV-ECMO 患者的骨骼肌萎缩和功能障碍，并可能提高患者的生活质量。
早期康复方案对床边护士提出了更高的要求。它要求他们密切观察 VV-ECMO 患者的情况，及时评估康复的可行性，并监测任何不良反应。超声测量是评估 ICU 患者肌肉萎缩的一种非侵入性且有用的工具。早期康复方案可有效改善 VV-ECMO 患者的骨骼肌萎缩和功能障碍。
