Khwaja Sajad A, Habib Mohammad A, Gupta Rajesh, Singla Deepika, Basista Ruchi
Department of Physiotherapy, Jamia Hamdard, New Delhi, IND.
Department of Medicine, Hamdard Institute of Medical Sciences & Research (HIMSR), New Delhi, IND.
Cureus. 2024 Nov 1;16(11):e72847. doi: 10.7759/cureus.72847. eCollection 2024 Nov.
Patients afflicted with chronic obstructive pulmonary disease (COPD) frequently manifest acute respiratory failure (ARF), characterized by hypercapnia, hypoxia, malnutrition, muscle weakness, heightened work of breathing (WOB), recurrent acute exacerbations, reliance on mechanical ventilation (MV), and difficulties in the weaning phase. Early implementation of rehabilitation interventions holds promise in mitigating prolonged MV and, consequently, reducing intensive care unit (ICU) morbidity and mortality.
A prospective study was undertaken involving COPD type 2 respiratory failure patients receiving MV in an ICU setting. Random assignment was employed to allocate patients to either the experimental or control groups. Both groups received chest physiotherapy, range-of-motion exercises, and standard medical and nursing care. The experimental group additionally underwent early active rehabilitation exercises, including limb strength training and progressive mobility tasks. Various parameters such as mechanical ventilator duration, ICU length of stay (LOS), mortality, and occurrence of adverse events were documented. Group differences were analyzed using independent t-tests.
Among 52 patients, 33 were assigned randomly to each group using sealed envelopes. After withdrawals, 15 patients remained in each group. The experimental group had significantly shorter durations of MV (2.29 ± 0.61 vs 2.86 ± 0.66 days; 95% CI: -1.06 to -0.07, t = -2.37, P = 0.02) and ICU stay (7.66 ± 1.17 vs 8.86 ± 1.68 days; 95% CI: -2.28 to -0.11, t = -2.26, P = 0.03) compared to the control group. ICU mortality rates were similar between groups (1.93 ± 0.25 vs 1.93 ± 0.25; 95% CI: -0.19 to 0.19, t = 0.00, P = 1.00). The experimental group had a higher incidence of non-serious adverse events (0.66 ± 0.48 vs 0.26 ± 0.45 events; 95% CI: -0.04 to -0.75, t = 2.31, P = 0.02) and primarily transient physiological changes.
Engaging the early active rehabilitation exercises for mechanically ventilated COPD patients is practical and results in a reduction in MV duration, consequently shortening the ICU LOS.
慢性阻塞性肺疾病（COPD）患者常出现急性呼吸衰竭（ARF），其特征为高碳酸血症、低氧血症、营养不良、肌肉无力、呼吸功（WOB）增加、反复急性加重、依赖机械通气（MV）以及撤机困难。早期实施康复干预有望减轻MV时间延长，从而降低重症监护病房（ICU）的发病率和死亡率。
进行了一项前瞻性研究，纳入在ICU接受MV的2型呼吸衰竭COPD患者。采用随机分配将患者分为实验组或对照组。两组均接受胸部物理治疗、关节活动度锻炼以及标准的医疗和护理。实验组额外进行早期主动康复锻炼，包括肢体力量训练和渐进性活动任务。记录了各种参数，如机械通气时间、ICU住院时间（LOS）、死亡率和不良事件的发生情况。使用独立t检验分析组间差异。
52例患者中，每组使用密封信封随机分配33例。剔除后，每组各有15例患者。与对照组相比，实验组的MV时间显著缩短（2.29±0.61天对2.86±0.66天；95%CI：-1.06至-0.07，t=-2.37，P=0.02），ICU住院时间也显著缩短（7.66±1.17天对8.86±1.68天；95%CI：-2.28至-0.11，t=-2.26，P=0.03）。两组的ICU死亡率相似（1.93±0.25对1.93±0.25；95%CI：-0.19至0.19，t=0.00，P=1.00）。实验组非严重不良事件的发生率较高（0.66±0.48次对0.26±0.45次；9%CI：-0.04至-0.75，t=2.31，P=0.02），主要为短暂的生理变化。
对接受机械通气的COPD患者进行早期主动康复锻炼是可行的，可缩短MV时间，从而缩短ICU住院时间。
