Effect Of Early Goal Directed Mobilisation On ICU Acquired Weakness In ICU Patients With Mechanical Ventilation

PurposeTo construct early goal directed mobilisation rehabilitation scheme,and compare the application effect of this protocol with conventional measures in ICU patients with mechanical ventilation.To investigate the effect of this protocol on patients'muscle strength,ICU acquired weakness incidence rate,mobility capacity,self-care ability,mechanical ventilation time,length of stay in ICU and total length of stay and to analyze the safety and feasibility of its application.MethodsThis study is a kind of experimental study,using convenient sampling,according to the admission order in a grade iii first-class general hospital in Nanchang city,40patients with mechanical ventilation in intensive care department from November2018 to May 2019 were selected as intervention group,and 40 patients with mechanical ventilation in intensive care department from June 2019 to December2019 were selected as control group.At the beginning of ICU treatment,the intervention group received EGDM rehabilitation therapy within 24 hours after the stable vital signs,while the control group received ICU routine rehabilitation therapy.To analyze and compare the differences between the two groups in general data during the intervention period,the British council muscle strength score?MRC?and the self-care ability scale?BI?were analyzed and compared before and on the third and seventh days after the intervention.The ICU-AW incidence,mobility capacity?ICU Mobility Scale?,mechanical ventilation time,length of stay in ICU,total length of stay in ICU and occurrence of adverse events were compared between the two groups.Data of patients'vital signs and blood oxygen saturation before and after early rehabilitation on the 7th day of intervention were collected,and the status of vital signs and blood oxygen saturation before and after intervention?10 min after the beginning of early mobility?and after intervention?10 min after the end of early mobility?were compared.Results1.General information the study eventually included 80 subjects,40 in the control group and 40 in the intervention group.There was no statistically significant difference between the two groups in patients'age,gender,disease category and APACHE?score and cultural level?P>0.05?.2.MRC strength score and BI score The MRC scores before the intervention?after 3 days of intervention and 7 days after intervention of the two groups were shown by two factors of repeated measurements of variance analysis.The time effect(F _time=84.127,P<0.001),grouping effect(F_group=9.017,P=0.001)and interaction effect(F _interaction=21.580,P<0.001)of MRC score in the two groups were statistically significant?P<0.05?.The results of multivariate analysis showed that there was no statistically significant difference in MRC scores between the two groups before and 3 days after intervention?P>0.05?,while there was a statistically significant difference in MRC scores between the two groups on the 7th day after intervention?P<0.05?.BI scores of the two groups of patients before,3 days after,and 7 days after intervention were measured by two-factor repeated measurement analysis of variance.The results showed that the time effect(F _time=186.614,P<0.001),grouping effect(F_group=20.429,P<0.001)and interaction effect(F _interaction=6.258,P=0.005)of BI scores of the two groups of patients were statistically significant?P<0.05?.The results of multivariate analysis showed that there was no statistically significant difference in BI scores between the two groups before intervention?P>0.05?,but there was a statistically significant difference in BI scores between the two groups 3 days after intervention and 7 days after intervention?P<0.05?.3.ICU-AW incidence,ICU patient mobility?IMS scale?,mechanical ventilation time,length of stay in ICU and total length of stay The incidence of ICU-AW during ICU stay in the two groups was compared,with 14?35%?cases in the control group and 6?15%?cases in the intervention group,and the difference was statistically significant?P<0.05?.The ICU mobility scale score of the control group was lower than that of the intervention group[?5.23±1.53?VS?6.10±1.52?],and the difference was statistically significant?P<0.05?.The mechanical ventilation time of the control group was higher than that of the intervention group[?9.50±2.87?days VS?7.35±3.33?days].The length of ICU stay in the control group was higher than that in the intervention group[?14.10±4.75?days VS?10.35±3.53?days].The total length of stay in the control group was higher than that in the intervention group[?24.83±7.21?days VS?18.63±5.81?days],and Their differences were statistically significant?P<0.05?.4.Safety index No serious adverse events such as accidental tube extubation and falls occurred in the intervention group.The vital signs and blood oxygen saturation were compared before,during and after the intervention on day 7?10 min after the beginning of early mobility?and after the intervention?10 min after the end of early mobility?.The data showed that there was no statistically significant difference in the vital signs and peripheral oxygen saturation of patients before,during and after the intervention?P>0.05?.Conclusions1.EGDM rehabilitation scheme can improve the ICU mechanical ventilation in patients with muscle,effectively prevent or reduce the occurrence of ICU-AW,improve patients'self-care ability,enhance the patients'ability to move when they are transferred out of ICU,shorten mechanical ventilation,ICU hospitalization and the total length of stay,promote the patients'recovery,and the intervention has achieved the expected efficacy and has certain social and economic benefits.2.The early goal-directed rehabilitation scheme provides a safe,effective,economical and feasible early rehabilitation strategy for patients with mechanical ventilation in ICU,and also provides a new practical way to prevent the occurrence of ICU-AW,which has certain clinical application value.