机械呼吸机脱机康复计划

实验性的：Group A (study group)

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

其他：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

其他名称：

• 全面的物理治疗康复计划

有源比较器：Group B (Control group)

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

其他：传统胸部理疗康复方案结合吸气肌训练

研究组采用同样的吸气肌训练结合传统理疗方案，包括体位、改良体位引流、叩击、振动。

其他名称：

• 传统理疗康复计划

两组成功脱机的百分比

当急性呼吸衰竭的根本原因稳定或显着改善时，将使用自主呼吸试验，并考虑每天评估患者是否准备好停止呼吸机。 自主呼吸试验将持续 30 分钟至 120 分钟并结合 CPAP，如果试验失败，患者将恢复完全通气支持至少 24 小时，然后再进行新的试验。脱机成功定义为拔管和拔管后 48 小时没有通气支持

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