Bargahi Mohammad, Alavi-Moghaddam Mostafa, Karimi Mehdi, Azizan Zahra, Jafarzadeh Fateme, Javaherian Mohammad, Soleimantabar Hussein, Mirbehbahani Seyed Hamidreza
Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Arch Acad Emerg Med. 2024 May 18;12(1):e51. doi: 10.22037/aaem.v12i1.2244. eCollection 2024.
Various treatment protocols have been recommended since the beginning of the COVID-19 pandemic and have gradually evolved. This study aimed to assess the effectiveness and safety of incentive spirometer exercise (ISE) in outcomes of hospitalized patients with moderate-to-severe COVID-19 pneumonia.
A 3-month single-blind, two parallel-armed randomized controlled trial was conducted at Imam Hossein Hospital, Tehran, Iran. Participants aged >18 years with documented COVID-19 pneumonia were randomly allocated to 2 groups of IS (ISE in addition to the usual treatment) and control (usual care alone). The IS group was also asked to perform ISE after discharge for three months. The primary outcomes were peripheral O2 saturation (SpO2), VBG parameters (pCO2, PH, HCO3), dyspnea level measured by Modified Borg Scale (MBS), length of hospital stay (LOS), and respiratory rate (RR). Secondary outcomes included mortality rate, intubation rate (IR), and ICU admission rate.
A total of 160 eligible patients were randomly assigned to either the IS (n = 80) or control (n=80) groups. Although there were no significant differences in primary and secondary outcomes between the groups post-intervention, adjusted analysis showed that participants allocated to the IS group had significantly higher SpO2 levels and lower RR, MBS levels, and LOS. Also, the adjusted model analysis showed a marginal statistically significant difference between groups in secondary outcomes, such as IR, the 1-month mortality rate, and the 3-month mortality rate.
It seems that adding the ISE to usual care in the early treatment setting of COVID-19 patients resulted in a relatively significant increase in SpO2 levels, improved respiratory status, and marginally decreased LOS. Additionally, ISE minimally reduced ICU admissions and intubation rates, with no significant impact on in-hospital or long-term mortality in patients with COVID-19 pneumonia.
自新冠疫情开始以来，人们推荐了各种治疗方案，且这些方案也在不断演变。本研究旨在评估激励肺量计锻炼（ISE）对中重度新冠肺炎住院患者治疗效果及安全性的影响。
在伊朗德黑兰的伊玛目侯赛因医院进行了一项为期3个月的单盲、双臂平行随机对照试验。年龄大于18岁且确诊为新冠肺炎的患者被随机分为两组，即干预组（在常规治疗基础上加用ISE）和对照组（仅接受常规护理）。干预组患者出院后还需进行3个月的ISE。主要观察指标包括外周血氧饱和度（SpO2）、静脉血气（VBG）参数（pCO2、PH、HCO3）、采用改良博格量表（MBS）测量的呼吸困难程度、住院时间（LOS）和呼吸频率（RR）。次要观察指标包括死亡率、插管率（IR）和重症监护病房（ICU）入住率。
共有160例符合条件的患者被随机分配至干预组（n = 80）或对照组（n = 80）。尽管干预后两组的主要和次要观察指标无显著差异，但校正分析显示，分配至干预组的患者SpO2水平显著更高，RR、MBS水平和LOS更低。此外，校正模型分析显示，两组在次要观察指标（如IR、1个月死亡率和3个月死亡率）上存在边缘统计学显著差异。
在新冠肺炎患者的早期治疗中，在常规护理基础上加用ISE似乎能使SpO2水平显著升高，改善呼吸状况，并略微缩短住院时间。此外，ISE可使ICU入住率和插管率略有降低，对新冠肺炎患者的院内或长期死亡率无显著影响。
