Effects Of Early Passive Activities On ICU Acquired Weakness In Patients With Mechanical Ventilation

Objective: To investigate the effects of different forms of passive activity on ICU acquired weakness(ICU-AW)in patients with mechanical ventilation.Methods: A clinical randomized controlled trials.Will meet the inclusion and excluding the standard of 178 patients with mechanical ventilation,and were divided into four groups according to the random numbers : the control group(group A: routine nursing),manual passive group(group B: routine nursing + manual passive activities),neuromuscular electrical stimulation(NEMS)group(group C: routine nursing + NMES)and treatment group(D group: conventional treatment + manual passive activity + NMES).In patients receiving mechanical ventilation(within24 hours)to implement different intervention vital signs were stable after 4 hours,respectively in patients with mechanical ventilation of 0,3,5,7 day measuring four groups of patients limb muscle strength grade(MRC),upper limb muscle strength,lower extremity muscle strength,well the change of inspiratory muscle(MIP);Intervention before and after intervention and patients breathing(RR),heart rate(HR),monitoring the blood oxygen saturation(SPO2),central venous pressure(CVP),systolic blood pressure(DBP),diastolic blood pressure(SBP);Record the patient's mechanical ventilation,stay in ICU,total hospital stay,second week off-line rate and28-day survival rate?Results: 1.For muscle strength(1)The analysis of variance between groups showed that intervention and time factors had significant effect on MRC,upper limb muscle strength and lower limb muscle strength score,and there was significant interaction(P <0.05);There was a significant difference between the two groups(P <0.05);in group A and group C at day 3 and day7,in upper limb muscle strength at day 7(P <0.05);in the lower limb muscle strength at the 3rd,5th and 7th day(P <0.05);in MRC and lower extremity muscle strength between group B and group D at day 5 and day 7(P <0.05);in MRC and lower extremity muscle strength scores between group A and group D at 3,5 and 7 days(P <0.05),in upper limb muscle strength at day 7(P <0.05).(2)For MIP :The variance analysis of MIP showed significant effect on intervention and time(P <0.05),but there was no interaction(P> 0.05).There was a significant difference between group A and C group at the 3,5,7 days difference(P <0.05);group B and group D on day 7(P<0.05);group A and group D at 3,5 and 7 days(P <0.05).(3)There was a positive correlation between MRC and MIP in the four groups(r= 0.243,0.198,0.138,0.148),A and B were statistically significant(P <0.05).2.For ICU-AW incidence.With the prolongation of time in patients with mechanical ventilation,the incidence of ICU-AW in each group was increasing;There was significant difference between group A and group C,group B and group D on day 7(P <0.05),A group and D group from the first5,7 days difference(P <0.05).3.For hemodynamics There was no significant difference in RR,CVP,DBP and SBP between the four groups before and after the intervention(P> 0.05);There was no significant difference in HR and SPO2 between group A and group B before and after intervention(P> 0.05);The HR and SPO2 of group C were different at 0,3 and 5 days(P <0.05);in SPO2 between day 0 and day 3(P<0.05),at 0,3,5 and 7 days(P <0.05).4.F or clinical outcome APACHE ? no difference between the groups(P> 0.05);There was a significant difference in mechanical ventilation between group A and group C(P <0.05);in mechanical ventilation time,stay in ICU time between group B and group D(P <0.05);The time of mechanical ventilation and the ICU were significantly different between group A and group D(P <0.05);Total hospitalization time,second week off-line rate,28-day survival rate between the groups no difference(P> 0.05).Conclusion: 1.The early manual passive group,neuromuscular stimulation group and combination intervention group were effective in improving or maintaining the muscle strength of patients with mechanical ventilation and reducing the incidence of ICU-AW.2.Neuromuscular stimulation group compared with the early manual passive group,to improve or maintain the mechanical ventilation of the muscle strength,reduce the incidence of ICU-AW effect is better;compared to neuromuscular electrical stimulation group,early manual passive group,combined intervention.3.Neuromuscular electrical stimulation group,combined intervention group can reduce the patient's heart rate,improve oxygen saturation;mechanical ventilation in patients with early passive activity is safe.4.Early passive interventions can shorten the time of mechanical ventilation,occupying ICU time.