Effect Of Early Goal-directed Mobilisation On Prevention Of ICU Acquired Weakness In RICU Patients With Mechanical Ventilation

Objective:To explore the value of Early-goal directed mobilisation(EGDM)in preventing ICU-acquired weakness(ICU-AW)in patients with invasive mechanical ventilation in respiratory intensive care unit(RICU),and to evaluate its effectiveness and safety.Methods:According to the research method of quasi-experimental study,80 patients with mechanical ventilation who were admitted to the respiratory intensive care unit of a third-grade hospital in Hunan Province from January 2018 to December 2018 and met the inclusion criteria were grouped according to the time order of admission,40 cases admitted from January 2018 to June were included in the control groups and 40 cases admitted from July 2018 to December were set as observation groups.Both groups of patients were given life support,symptomatic support treatment and other RICU routine treatment,The activity plan was implemented from the day after enrollment,the RICU routine activity plan was adopted in the control group,while the early goal direced mobilisation(EGDM)was used in the observation group.The EGDM team carried out an EGDM assessment of the patients in the observation group,setting daily activity targets and implementing specific procedures based on the patient's conscious state and muscle strength levels.Daily activity goals included level 1(passive range of activities on the bed),level 2(sitting),level 3(standing)and level 4(walking).The data of the two groups of patients were then compared,including:?General information;?ICU-AW occurrence:the third and seventh day of the American Council for Medical Research(Medical research Council,MRC)muscle strength score,grip strength,ICU-AW incidence;? Self-care ability indicators:Barthel index score at discharge(Barthel Index,BI);?Respiratory function Index:Airway Resistance,pulmonary compliance and endogenous PEEP on the third and seventh days;? Early prognostic indicators:Mechanical ventilation time,ICU hospitalization days,total hospitalization days;? Safety indicators:Changes in the vital signs of respiratory frequency,heart rate,systolic pressure and blood oxygen saturation before and after the implementation of EGDM in the observation group on the third and seventh days.In this study,SPSS22.0 software was used for statistical analysis,and the statistical description of metering data was expressed by the mean± standard deviation(x ±s).For the comparison of the two sample means,if the normal distribution is distributed and the variance is uniform,the grouped t test is used.If the variance is not uniform,the Wilcoxon rank sum test is used.For the two groups of different time points,the variance analysis was used to measure the variance of the design data.The statistical description of the count data was expressed by frequency and percentage.The comparison between the two groups was performed by x2 test.For the comparison of the two sets of grade data,the Wilcoxon rank sum test was used to compare two independent samples;when P<0.05,the difference was considered statistically significant.Results:1.A total of 80 patients with mechanical ventilation were included,40 cases in the control group,40 cases in the observation Group.A case of air tube detachment occurred in both the control group and the observation group,and a total of 78 patients completed the study.The two groups of patients were compared with General information,basic disease diagnosis,BMI,blood glucose(at admission),pre-hospital BI score,APCHII score,CRP,PaO2,PaCO2,Raw,Cl,and PEEPi.There was no statistically significant difference(all P>0.05).2.There was no significant difference in the MRC score between the observation group and the control group on the third day(t=0.827,P=0.411).There was a statistically significant difference in the MRC score between the observation group and the control group(P<0.05).There was a significant difference in the MRC scores on the third day and the seventh day(P<0.05);there was interaction between the groups and time(P<0.05).The change trend of MRC score between the control group and the observation group was inconsistent with the extension of hospitalization time.The MRC score of the control group decreased with the extension of hospitalization time,while that of the observation group remained unchanged with the extension of hospitalization time.There was no significant difference in the grip strength between the observation group and the control group on the third day.(P>0 05).The grip strength of the observation group and the control group on the seventh day was(30.95±3.85)and(26.82±4.73)(kg)for men,(18.96±4.26)and(16.03±5.38)(kg)for women respectively,with a significant difference(P<0.05).There was no significant difference in the incidence of ICU-AW between the observation group and the control group on the third day(P>0.05).There was no significant difference between the two groups(P>0.05).The number of ICU-AW cases in the observation group and the control group on the seventh day was 4 and 11 respectively,and the difference between the two groups was statistically significant(P<0.05).The number of ICU-AW cases in the observation group and the control group were 5 and 14 respectively when they were discharged from hospital.The difference between the two groups was statistically significant(P<0.05).3.The BI scores of discharged patients in the observation group and the control group were(66.90±14.81)and(59.39±15.84),respectively,with statistical significance(P<0.05).4.The Raw?C1 and PEEPi of the observation group and control group on the third day were 20.35±7.15,23.23±6.64(cmH2O/(L·s)),27.46±5.45,24.40±6.68(mL/cmH2O),6.23±2.83,7.42±2.63(cmH2O);in the observation group and control group on the seven day were 15.01±3.40?19.01±4.70(cmH2O/(L·s)),42.91±4.70?34.30±5.31(mL/cmH2O),4.46±2.2.21?5.92±2.50(cmH2O),the comparison between the two groups The difference was statistically significant(P<0.05).5.The duration of mechanical ventilation,ICU hospitalization and total hospitalization of the patients in the observation group and the control group were 148.50±17.20?172.70±16.50h,7.07±3.91?9.33±1.72d,12.04±3.66?15.23±2.02d,respectively.There were significant differences between the two groups(P<0.05).6.There was no significant difference in heart rate,systolic blood pressure and Sp02 between the observation group and the third day before the implementation of EGDM(P>0.05),while the respiratory frequency was 24.50±4.15?26.56±3.17 times/min,with a significant difference(P<0.05).The differences of respiratory rate,heart rate,systolic pressure and oxygen saturation before and after EGDM were22.35±3.56?24.78±2.89 times/min,95.67±15.56?102.65±11.95 times/min,115.67±9.63?124.45±18.21 mmHg,96.31±1.52?95.36±1.98(%)in the observation group on the seventh day,All indicators did not meet the event termination criteria(P<0.05).Conclusion:1.Early goal directed mobilisation can improve MRC muscle strength score,grip strength and self-care ability of patients with mechanical ventilation in RICU.2.Early goal directed mobilisation have important value in preventing ICU acquired weakness in RICU mechanical ventilation patients.3.Early goal-directed mobilisation can improve respiratory mechanics and early prognosis in RICU mechanical ventilation patients.4.Early goal-directed mobilisation were implemented in RICU mechanically ventilated patients,which were relatively safe under the overall assessment.