人工呼吸器からの離脱のためのリハビリテーション プログラム

実験的：Group A (study group)

Forty-five patients will receive a comprehensive rehabilitation programme combined with inspiratory muscle training.

他の：Comprehensive physical therapy rehabilitation program combined with inspiratory muscle training

A threshold inspiratory muscle trainer will be connected to the artificial airway with 15 mm and 22 mm adaptors. Training bouts consist of three to five sets of six repetitions breathing through the trainer. Training will be conducted with the patient in bed with an approximately 30° head-up tilt and with intensity about 50 % of maximal inspiratory pressure. Patients will be returned to mechanical ventilation for rest between training sets as needed. Three to five sets of six training breaths will be completed for a total of 18 to 30 training breaths per session. Following each training set, the patient indicated a rating of perceived inspiratory exertion on modified Borg scale . The study group will also receive comprehensive rehabilitation program consist of upper-extremity exercises, lower extremity exercises, pedaling exercises, trunk control exercises and bedside functional training

他の名前：

• 包括的な理学療法リハビリテーション プログラム

アクティブコンパレータ：Group B (Control group)

Forty-five patients will receive traditional chest physical therapy combined with inspiratory muscle training.

他の：吸気筋トレーニングと組み合わせた伝統的な胸部理学療法リハビリテーションプログラム

従来の理学療法プログラムと組み合わせた研究グループの同じ吸気筋トレーニングは、ポジショニング、修正姿勢ドレナージ、パーカッション、振動で構成されています。

他の名前：

• 伝統的な理学療法リハビリテーション プログラム

両方のグループで成功した離乳率

自発呼吸試験は、急性呼吸不全の根本的な原因が安定するか、大幅に改善され、人工呼吸器の中止に対する患者の準備が整っているかどうかを毎日評価する場合に使用されます。 自発呼吸の試行は、CPAP と組み合わせて 30 分から 120 分続きます。試行が失敗した場合、患者は、新しい試行を実行する前に、少なくとも 24 時間完全な換気サポートに戻ります。ウィーニングの成功は、抜管と定義されます。抜管後 48 時間の換気サポートの欠如

inspiratory muscle strength (MIP)

The mechanical ventilator will be used to measure the plateau pressure (maximal inspiratory pressure). Plateau pressure was measured using the inspiratory hold function on the venilator while the patient will be sedated and on volume control mode (Sidebotham et al., 2007) The plateau pressure will be measured by ventilator in millibar then it converted to cm o by multiplying it by 1.01971621298 (1millibar equals 1.01971621298 cm 0) and near the figure to the nearest two decimal places

Upper and lower extremity muscle strength

Upper and lower extremity muscle strength will be assessed using a handheld dynamometer. The shoulder flexor, elbow flexor, and knee extensor muscle groups w ill be included in the measurements. Standard test positions will be modified because all patients in this study are using mechanical ventilator and unable to sit up at initial examination. The shoulder and elbow flexors will be tested in the semi-Fowler position. The isometric force of the shoulder flexors will be tested with the shoulder flexed 90 degrees and the elbow in extended position. The dynamometer will be placed just proximal to the epicondyles of the humerus, and the patients will be stabilized at the axillary region. The isometric force of the elbow flexors will be tested with the elbow flexed 90 degrees, the forearm supinated, and the shoulder in neutral position; the dynamometer will be placed just proximal to styloid processes of ulna and radius, and the patients will be stabilized at the superior aspect of

The Functional Independence Measure (FIM)

5 activities with The Functional Independence Measure (FIM) were measured, which are bathing, dressing, moving from bed to chair, bowel management, and bladder management.

Rapid shallow breathing index (RSBI)

The rapid shallow breathing index (RSBI) was determined by dividing the number of breaths per minute (f) by the tidal volume (TV) in liters obtained from a mechanical ventilator

Pain level

were assessed using a 10 cm visual analog scale (VAS). Participants evaluated their pain intensity on a scale from 0 (no pain) to 10 (most severe pain possible).

days to wean

Number of days to weaning