기계식 인공호흡기 중단을 위한 재활 프로그램

실험적: Group A (study group)

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

다른: 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

다른 이름들:

• 종합 물리치료 재활 프로그램

활성 비교기: Group B (Control group)

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

다른: 흡기 근육 훈련과 결합된 전통적인 흉부 물리 치료 재활 프로그램

전통적인 물리 치료 프로그램과 결합된 연구 그룹에 대한 동일한 흡기 근육 훈련은 위치 지정, 수정된 체위 배액, 타진, 진동으로 구성됩니다.

다른 이름들:

• 전통적인 물리 치료 재활 프로그램

두 그룹의 성공적인 젖떼기 비율

자발 호흡 시험은 급성 호흡 부전의 근본적인 원인이 안정되거나 상당히 개선되고 인공호흡기 중단에 대한 환자의 준비 상태에 대한 일일 평가가 고려될 때 사용될 것입니다. 자발 호흡 시도는 CPAP와 결합하여 30분에서 120분 동안 지속되며 시도가 실패한 경우 환자는 새로운 시도를 수행하기 전에 최소 24시간 동안 완전한 인공호흡 지원으로 돌아갑니다. 이유 성공은 발관으로 정의되며 발관 후 48시간 동안 환기 지원 부재

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