Care Bundle On Mechanical Ventilation Time In Patients With Chronic Obstructive Pulmonary Disease (COPD) Undergoing Mechanical Ventilation

ObjectiveTo evaluate the clinical efficacy of the care bundle which based on early exercis e-nutrition support-sleep management in patients with chronic obstructive pulmonary d isease（COPD）undergoing mechanical ventilation.MethodsThis study is a single-center randomized controlled study.A total of 84 eligible p atients with chronic obstructive pulmonary disease were randomly divided into the ex perimental group and the control group.There were 42 cases in each group.The contr ol group received conventional nursing care in intensive care unit.The experimental gr oup adopted routine nursing methods and care bundle which based on early exercise-nutrition support-sleep management.Total mechanical ventilation time（including invasive mechanical ventilation time and non-invasive mechanical ventilation time）,oxygen par tial pressure（PaO₂）,carbon dioxide partial pressure（PaCO₂）,arterial oxygenation index（OI）,albumin（ALB）,prealbumin（PAB）,delirium,ICU residence time and 28-day mortalit y rate were observed in the two groups.ResultsBefore mechanical ventilation,there was no significant difference in age（66.02±6.86 vs.64.71±8.06,P=0.425）,gender（M/F）（35/7 vs.38/4,P=0.332）,APACHE II score（17.93±4.14 vs.18.55±4.84,P=0.530）,oxygenation index before mechanical ventilation（198.70±60.38 vs.207.90±69.81,P=0.522）,Partial Pressure of Carbon Dioxide before mechani cal ventilation（67.76±13.00 vs.70.62±10.63,P=0.296）,white blood cell count（13.98±3.34vs.14.31±3.31,P=0.980）,procalcitonin（1.77±1.32 vs.2.09±1.70,P=0.622）,prealbumin（140.40±35.20 vs.151.00±39.56,P=0.279）and albumin（26.26±4.05 vs.27.86±3.79,P=0.066）between the two groups before（P>0.05）.There was no significant difference in pre vious hypertension（27 vs.31,P=0.345）,coronary heart disease（19 vs.20,P=0.827）and diabetes（15 vs.16,P=0.821）.The total mechanical ventilation time of the experimental group was less than that of the control group,and the difference was statistically sig nificant（9.64±2.32 vs.12.86±2.74,P<0.001）.The invasive mechanical ventilation time o f the experimental group was significantly less than that of the control group（8.31±2.57 vs.11.24±3.02,P<0.001）.There was no significant difference in noninvasive mechan ical ventilation time between the two groups（1.33±1.00 vs.1.62±1.15,P=0.317）.The lev el of proalbumin in the experimental group was higher than that in the control group at day 9,and the difference was statistically significant（228.40±26.77 vs.215.70±26.95,P=0.014）.On day 9,the oxygenation index of the experimental group was higher t han that of the control group（289.70±53.65 vs.263.40±51.08,P=0.020）.PaCO₂ of the experimental group was lower than that of the control group When they transferred out of the ICU（43.02±10.74 vs.48.12±6.48,P<0.001）.The incidence of delirium in th e experimental group was lower than that in the control group,and the difference w as statistically significant（14.29%vs.33.33%,P=0.040）.Total time in the ICU was les s in the treatment group than in the control group（14.81±2.33 vs.17.86±2.74,P<0.001）.At day 28,there was no significant difference in mortality between the two grou ps（11.90%vs.16.67%,P=0.533）.No serious adverse events were found in either grou p.ConclusionThe care bundle which based on early exercise-nutrition support-sleep manageme nt has a significant clinical effect on patients with mechanical ventilation of chronic obstructive pulmonary disease,The care bundle is not only safe but also feasible.