Analysis of the effects of a goal-oriented pulmonary rehabilitation training program based on patients with ventilator withdrawal difficulties in the ICU.

BACKGROUND

Difficult weaning from mechanical ventilation in ICU patients prolongs hospitalization and increases risks of complications like ventilator-associated pneumonia and ICU-acquired weakness. While standard care (airway management and early functional exercise) is routine, outcomes remain suboptimal. This study evaluated a nurse-led, goal-directed pulmonary rehabilitation program to improve weaning success, reduce weaning time, and enhance physiological/functional recovery in this high-risk population.

METHODS

Using convenience sampling, 70 ICU patients with difficult weaning (admitted August 2023-July 2024) were divided into historical control and observation groups (35 each). The control group (August 2023-January 2024) received standard airway care and early functional exercise. The observation group (February-August 2024) received additional nurse-led pulmonary rehabilitation, including individualized goal setting, progressive respiratory training (using continuous positive airway pressure/synchronized intermittent mandatory ventilation protocols), daily sedation-pain-agitation monitoring (Richmond Agitation-Sedation Scale/Care Pain Observation Tool), and muscle strengthening guided by the ICU Mobility Scale. Outcomes compared included weaning success rate, weaning time, oxygenation index (PaO₂/FiO₂), muscle strength (Medical Research Council scale), and self-care ability (Barthel Index), with statistical significance set at P < .05.

RESULTS

The observation group demonstrated significantly higher weaning success rates and shorter weaning times versus controls (P < .05). While pre-intervention oxygenation indices showed no difference (P > .05), post-intervention PaO₂/FiO₂ ratios were significantly higher in the observation group (P < .05). Muscle strength (Medical Research Council scores) and self-care ability (Barthel Index scores) also showed statistically significant improvements in the intervention group after treatment (P < .05).

CONCLUSION

The nurse-led, goal-directed pulmonary rehabilitation program significantly accelerates weaning, increases success rates, and improves oxygenation, muscle strength, and self-care ability in difficult-to-wean ICU patients. It represents an effective enhancement to standard care and is recommended for broader clinical implementation.