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Background At present, the practice of pulmonary rehabilitation for pneumoconiosis in China is in a primary stage. The basis for formulating an individualized comprehensive pulmonary rehabilitation plan is still insufficient, which is one of the factors limiting the development of community-level rehabilitation work. Objective To formulate an exercise prescription based on maximum heart rate measured by cardiopulmonary exercise test (CPET), conduct an individualized comprehensive pulmonary rehabilitation program with the exercise prescription for patients with stable pneumoconiosis, and evaluate its role in improving exercise endurance and quality of life, thus provide a basis for the application and promotion of pulmonary rehabilitation. Methods A total of 68 patients were recruited from the Occupational Disease Prevention Hospital of Jinneng Holding Coal Industry Group Co., Ltd. from April to August 2022 , and were divided into an intervention group and a control group by random number table method, with 34 cases in each group. All the pneumoconiosis patients participated in a baseline test. The control group was given routine drug treatment, while the intervention group received multidisciplinary comprehensive pulmonary rehabilitation treatment on the basis of routine drug treatment, including health education, breathing training, exercise training, nutrition guidance, psychological intervention, and sleep management, whose exercise intensity was determined according to the maximum heart rate provided by CPET. The rehabilitation training lasted for 24 weeks. Patients were evaluated at registration and the end of study respectively. CPET was used to measure peak oxygen uptake per kilogram (pVO2/kg), anaerobic threshold (AT), carbon dioxide equivalent of ventilation (EqCO2), maximum metabolic equivalent (METs), and maximum work (Wmax). The modified British Medical Research Council Dyspnea Questionnaire (mMRC), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Chronic Obstructive Pulmonary Disease Assessment Test (CAT), and Short Form of Health Survey (SF-36) were used to evaluate the potential effect of the comprehensive pulmonary rehabilitation program. Results Among the included 68 patients, 63 patients were having complete data, then 31 cases were assigned in the control group and 32 cases in the interventional group. Before the intervention, there was no significant difference in pVO2/kg, AT, EqCO2, METs, or Wmax between the two groups (P>0.05). At the end of the trail, the indicators like pVO2/kg [(19.81±2.38) mL·(min·kg)−1], AT [(14.48±2.33) mL·(min·kg)−1], METs (5.64±0.69), and Wmax [(85.25±14) W] of patients in the intervention group were all higher than those [(13.90±2.37) mL·(min·kg)−1, (11.70±1.94) mL·(min kg)−1, (3.97±0.70), and (61.77±14.72) W, respectively] in the control group (P<0.001); there was no significant difference in EqCO2 between the two groups (P=0.083). Before the trial, there was no significant difference in mMRC, SAS, SDS, PSQI, or CAT scores between the two groups (P>0.05). At the end of the trail, the mMRC score (1.16±0.57), SAS score (27.93±2.12), SDS score (26.48±1.44), PSQI score (1.08±0.88), and CAT score (4.34±3.28) of patients in the intervention group were lower than those [(2.03±0.83), (35.87±6.91), (34.23±6.65), (5.37±3.03), and (13.87±7.53), respectively] in the control group (P<0.001). The SF-36 scores of bodily pain (94.13±10.72), general health (87.50±5.68), vitality (95.31±5.53), mental health (99.88±0.71), and health changes (74.22±4.42) in the intervention group were higher than those [(71.87±32.72), (65.81±15.55), (74.52±16.45), (86.97±16.56), and (29.84±13.50), respectively] in the control group (P<0.001), and no significant difference was found in social functioning and role emotional scores (P>0.05). Conclusion Comprehensive pulmonary rehabilitation can increase the oxygen intake and exercise endurance of pneumoconiosis patients, ameliorate dyspnea symptoms, elevate psychological state and sleep quality, and improve the quality of life.
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@#BACKGROUND: Prolonged invasive respiratory support and extracorporeal membrane oxygenation (ECMO) in patients requiring urgent lung transplantation (ULTx) present significant challenges to clinical practice due to severe underlying diseases and complex conditions. The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center. METHODS: A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation (IMV) and ECMO between January 2018 and January 2023. Data were retrieved from electronic medical records at our lung transplant center. RESULTS: Fourteen patients (mean age 57.43±10.97 years; 12 males, 2 females) underwent ULTx with bridging ECMO and IMV. The mean body mass index was 23.94±3.33 kg/m², and the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 21.50±3.96. The Nutritional Risk Screening 2002 (NRS 2002) scores were ≥3. ULTx was performed after an 8.5-day waiting period (interquartile interval [IQR] 5.0-26.5 d). Following the surgeries, the average lengths of ECMO and IMV were 1.0 (IQR 1.0-2.0) d and 5.0 (IQR 3.0-7.3) d, respectively. The total length of hospital stay was 60.1±30.8 d, with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d. Two patients died within 30 d after ULTx, with a 30-day survival rate of 85.71%. CONCLUSION: Patients receiving ULTx showed an acceptable short-term survival rate, validating the practicality and safety of the treatment protocols implemented in our center.
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Primary lung cancer is a malignant tumor with the highest incidence and mortality in China, and lung rehabilitation for lung cancer has become a research hotspot. Many literature and studies have confirmed the feasibility and safety of pulmonary rehabilitation for lung cancer, but the mechanism of pulmonary rehabilitation for lung cancer is not completely clear. This article will discuss the mechanism of pulmonary rehabilitation for lung cancer, the specific content of pulmonary rehabilitation and remote home pulmonary rehabilitation.
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Objective:To summarize the best evidence of pulmonary rehabilitation in adult patients undergoing upper abdominal surgery and provide evidence-based basis for clinical intervention.Methods:Systematically searched clinical decisions, guidelines, expert consensus, evidence summary, systematic review and randomized controlled trial studies on pulmonary rehabilitation for patients undergoing upper abdominal surgery in UpToDate, Cochrane Library, Web of Science, PubMed, Embase, CINAHL, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, National Comprehensive Cancer Network, Guidelines International Network, Medlive, British Thoracic Society, European Respiratory Society, American Association for Cardiovascular and Pulmonary Rehabilitation, Canadian Thoracic Society, American Thoracic Society, WanFang Database, China National Knowledge Infrastructure, VIP Database, and China Biology Medicine. The retrieval time limit was from March 11, 2012 to March 11, 2022. Evidence was extracted, summarized and recommended after strict evaluation of literature quality.Results:A total of 19 pieces of literature were eligible for inclusion. They were 2 clinical decisions, 4 expert consensuses, 4 systematic evaluations, and 9 randomized controlled studies.The best evidence included 22 recommendations in 7 dimensions, namely pulmonary rehabilitation team, patient assessment, sports training, respiratory muscle training, drug rehabilitation, health education and quality control.Conclusions:Summary of the best evidence of pulmonary rehabilitation in patients undergoing upper abdominal surgery can provide evidence-based guidance for clinical intervention, but medical staff should also develop personalized training programs according to the actual situation of patients when applying the evidence.
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Objective:To analyze the related literature of pulmonary rehabilitation research at home and abroad, understand its research focus and development trend, and provide a reference and basis for future pulmonary rehabilitation research.Methods:Literature related to pulmonary rehabilitation published in the database of Web of Science and China National Knowledge Infrastructure from January 2015 to February 2022 was retrieved, and the contents such as the number of articles published annually, authors, research institutions, and high-frequency keywords were visually analyzed by bibliometrics and CiteSpace software.Results:The number of articles published each year showed an obvious upward trend from 2015, and the number of Chinese documents was higher than that of English documents from 2019 to 2020. MARTIJN A SPRUIT was the author with the largest number of articles published in English, with a total of 65 articles published, with close cooperation among scholars. Che Guowei was the author with the largest number of articles published in Chinese literature, with 13 articles published in total. The cooperation among the authors was relatively lacking and scattered. The main research institutions abroad were universities, and the institution with the highest number of papers was Maastricht University in the Netherlands, with a total of 85 articles. The research institutions cooperated closely and formed a cooperation network. Hospitals were the main research institutions in China, and the thoracic surgery Department of West China Hospital of Sichuan University had the highest total number of publications, with 14 articles. The cooperation among institutions was not close, and there was a lack of cooperation with universities and scientific research institutions. Through keyword co-occurrence and clustering and timeline view analysis, it was concluded that the research hotspots in this field were pulmonary rehabilitation of patients with different chronic respiratory diseases, the influence of pulmonary rehabilitation on lung function and quality of life of patients with chronic obstructive pulmonary disease, and the intervention methods of pulmonary rehabilitation. The future trend was predicted as the clinical application value of pulmonary rehabilitation in the treatment of lung cancer.Conclusions:At present, pulmonary rehabilitation research is in a stable development period. However, the cooperation between domestic authors and institutions is not close enough compared with foreign countries. In the future, China should strengthen the communication and cooperation between research teams, and learn from foreign research results to further develop the application of pulmonary rehabilitation in lung cancer patients, to promote the development of pulmonary rehabilitation research in China.
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Objective:To construct a quality evaluation index system of pulmonary rehabilitation for lung cancer patients in order to supply reference for evaluation of rehabilitation quality for lung cancer patients.Methods:This research adopted Delphi technique of non-experimental study. A total of 25 experts were invited to participate 2 rounds of letter enquiry from January to April in 2022. Literature retrieval, group discussion and Delphi method were used to establish the evaluation system of pulmonary rehabilitation for patients with lung cancer based on the social ecology theory.Results:The recovery rates of the two rounds of expert correspondence were 84%(21/25) and 100%(21/21), respectively, the expert authority coefficient was 0.824, and the Kendall′s W value was 0.279 and 0.186, respectively, which were statistically significant ( χ2=409.57, 218.23, both P<0.05). The finally formed quality evaluation index system of pulmonary rehabilitation for lung cancer patients based on social ecology theory included 4 first-level indicators, 11 second-level indicators, and 42 third-level indicators. Conclusions:The evaluation system of pulmonary rehabilitation for lung cancer surgery patients constructed in this study has certain scientificity and practicability, and provides a reference for the continuous improvement of the quality of care for lung cancer patients in our country.
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OBJECTIVE@#This study aimed to investigate the feasibility of implementing a manual therapy technique (muscle energy technique, MET) protocol in a hospital pulmonary rehabilitation (PR) program for patients with moderate to severe chronic obstructive pulmonary disease (COPD). Please cite this article as: Baxter DA, Coyle ME, Hill CJ, Worsnop C, Shergis JL. Muscle energy technique for chronic obstructive pulmonary disease: A feasibility study. J Integr Med. 2023; 21(3): 245-253.@*METHODS@#Participants aged 40 years and over, with moderate to severe COPD, were recruited into this 12-week study. The primary outcome measures were feasibility (acceptability of the intervention and attendance/adherence to the trial) and safety (adverse events, AEs). All participants received the MET and PR therapies. Participants and assessors were unblinded. Semi-standardized MET was delivered on 6 occasions (a maximum of once per week) at the hospital directly before a PR session. Participants undertook PR sessions as per the hospital program at a frequency of two days per week for 8 weeks. Participants were contacted 4 weeks after their final MET treatment via a telephone call to assess acceptability of the intervention.@*RESULTS@#Thirty-three participants were enrolled, with a median age of 74 years (range 45-89 years). The median number of MET sessions that participants attended was 5 (range 0-6) out of a possible 6 sessions (83% attendance). At follow-up, participants overwhelmingly enjoyed the MET treatment with some subjectively reporting improved breathing. There were no major AEs related to the intervention, with the majority of AEs classified as expected events related to COPD exacerbations.@*CONCLUSION@#It is feasible to implement a manual therapy protocol using MET as an adjunct to PR in a hospital setting. Recruitment rates were satisfactory and there were no AEs related to the MET component of the intervention.
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Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Feasibility Studies , Pulmonary Disease, Chronic Obstructive/therapy , Muscles , Quality of LifeABSTRACT
Bronchial asthma is a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness. With the development of the whole-life-cycle health concept, the focus of treatment for bronchial asthma in children has gradually shifted from initial pharmacological control to an integrated management model of functional rehabilitation and pharmacological assistance. As a non-pharmacological integrated approach, pulmonary rehabilitation plays an equally important role in the management of childhood asthma as pharmacological treatment. Studies have shown that breathing techniques such as Buteyko breathing, pursed lip breathing, diaphragmatic breathing training, threshold-pressure inspiratory muscle training and yoga breathing can improve lung function indicators such as FEV1, FVC, PEF and MVV in children. The comprehensive pre-exercise assessment, the development of exercise prescriptions, and the implementation and evaluation of exercise effects can improve the physical fitness, neuromuscular coordination and self-confidence of children with asthma. The comprehensive interventions of health education, psychological support and nutritional intervention can improve the compliance and effectiveness of rehabilitation training. This article reviews the research progress on respiratory training, physical exercise and comprehensive interventions in the pulmonary rehabilitation of asthmatic children, to provide theoretical basis and practical guidance for the scientific and rational management of pulmonary rehabilitation of asthmatic children in clinical settings.
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Background: It was observed that post?COVID patients reported persistent exertional dyspnea, cough, fatigue, or chest pain. About 10%–20% of patients may progress to pulmonary fibrosis. Pulmonary rehabilitation has been proven to be useful in improving effort tolerance and quality of life in chronic respiratory diseases. Objectives: The objective of this study was to assess the effectiveness of pulmonary rehabilitation in improving 6?min walk distance (6 MWD), peak flow, fatigue, anxiety, and depression in early postacute COVID disease. Materials and Methods: This quasi?experimental study was conducted during January 2021 to March 2021. The patients who recovered from COVID?19 and having persistent exertional dyspnea and fatigue after 3 weeks of recovery were included in the study. Baseline and postintervention assessment of 6 MWD, Visual Analog Scale for Fatigue (VAS?F), peak flow, and Hamilton rating scales (HAM) scales after 4 weeks were done. Compliance was ensured with weakly telemonitoring. Results: Significant improvement in peak flow, 6 MWD, Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), and VAS-F (P < 0.01) after 4 weeks of pulmonary rehabilitation. Conclusion: Early pulmonary rehabilitation in post?COVID syndrome can contribute to statistically significant improvement in functional and psychological parameters as well as post-COVID fatigue.
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Background: Patients with advanced lung cancer often suffer from poor mobility and quality-of-life (QoL). Pulmonary rehabilitation (PR) has been seen to improve exercise capacity and health-related QoL (HRQoL) in different respiratory diseases. Methods: The present study was conducted to evaluate the effect of PR in advanced non-operable non-small cell lung cancer patients on several outcomes compared to the control group. Forty eligible patients were randomized to receive chemotherapy and 8-weeks of supervised, hospital-based PR twice a week (cases) vs only standard chemotherapy (controls). Exercise capacity (6-minute walk distance), HRQoL, Functional Assessment of Cancer Therapy-Lung (FACT-L) scale, spirometry, dyspnea score [modified Medical Research Council (mMRC) grade] and arterial blood gas (ABG) analysis were measured in both the groups at baseline and at the end of 8 weeks. Results: After PR, there was significant improvement in the 6MWD (change in 6MWD: cases 16.3 + 34.3 m vs controls ?20.5 + 49 m; p = 0.03) and total FACT-L score (change in score: cases 18.9 + 7.3 vs controls ?8.8 + 13.4; p ?0.001) in the 揷ases� group as compared to controls. However, there was no significant improvement in dyspnea, spirometry, and ABG values. Conclusions: Comprehensive PR can improve exercise capacity and HRQoL in advanced lung cancer patients on concurrent chemotherapy. It may be an integral part of the management of these patients.
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We aimed to report a successful clinical case of a short-term cardiopulmonary rehabilitation after hospital discharge due to COVID-19. Exploratory descriptive case study with a 58-year-old male, former smoker, and in need of supplemental oxygen after COVID-19 infection, admitted to a car-diopulmonary rehabilitation program of six weeks in a school clinic in the Federal District, Brasília, Brazil. Chest expansion, aerobic capacity, physical function, and quality of life were evaluated before and after the program using, respectively, thoracic cirtometry, 6-Minute Walk Test, 1-Minute Sit-To-Stand Test, and Short Form Health Survey. At the end of the cardiopulmonary rehabilitation, the patient presented increased chest expansion, increased walked distance with decreased percep-tion of exertion, increased repetitions in the 1-minute sit-to-stand-test, and increased quality of life. Moreover, he was completely weaned from supplemental oxygen. A short-term duration cardiopul-monary rehabilitation protocol can contribute to improvement in aerobic and functional capacity, and in quality of life after COVID-19
O objetivo deste estudo foi relatar um caso clínico bem-sucedido de reabilitação cardiopulmonar de curta duração após alta hospitalar pós COVID-19. Trata-se de um estudo de caso exploratório descritivo com um homem de 58 anos, ex-tabagista e com necessidade de suplementação de oxigênio após infecção por CO-VID-19, admitido em um programa de reabilitação cardiopulmonar de seis semanas em uma clínica escola do Distrito Federal Brasília, Brasil. A expansão torácica, capacidade aeróbia, função física e qualidade de vida foram avaliadas antes e após o programa por meio de cirtometria torácica, teste de caminhada de 6 minutos, teste de sentar e levantar de 1 minuto e Short Form Health Survey, respectivamente. Ao final da reabilitação cardiopulmonar, o paciente apresentou aumento da expansão torácica, aumento da distância percorrida com diminuição da percepção de esforço, aumento das repetições no teste de sentar e levantar de 1 minuto e aumento da qualidade de vida. Além disso, o desmame completo do oxigênio suplementar também foi alcançado. Um protocolo de reabilitação cardiopulmonar, ainda que de curta duração, pode contribuir para a melhora da capacidade aeróbica, funcional e da qualidade de vida após a COVID-19
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Humans , Female , Middle Aged , Rehabilitation , Exercise , COVID-19 , LungABSTRACT
Objective:To explore the effects of grading pulmonary rehabilitation nursing on weaning trend among patients with mechanical ventilation in ICU.Methods:A total of 68 patients with mechanical ventilation from May 2018 to May 2019 in ICU of Guangzhou Red Cross Hospital were divided into the experimental group and the control group with 34 cases in each group by random digits table method. The control group was given routine rehabilitation nursing and the experimental group was given graded pulmonary rehabilitation nursing based on routine nursing. The differences between the two groups were compared in terms of rapid shallow breathing index(RSBI), oxygenation index, mechanical ventilation time, hospitalization time, success rate of weaning and incidence of complications.Results:On the 5th day and the 7th day after the intervention, the RSBI were 80.59 ± 5.69 and 75.74 ± 8.62 in the experimental group, which were significantly lower than those in the control group (89.54 ± 8.96 and 85.15 ± 9.75), ( t=5.06 and 4.28, both P<0.05). On the 3th, 5th, 7th day after the intervention, the oxygenation index were (244.82 ± 22.77), (248.21 ± 17.49) and (263.79 ± 17.31) mmHg in the experimental group, which were significantly lower than those in the control group (137.41 ± 15.01), (192.79 ± 15.82) and (206.26 ± 17.40) mmHg, ( t=22.97, 13.70, 13.67, all P<0.05). The duration of mechanical ventilation, length of ICU stay and the incidence of ventilator-associated pneumonia, deep venous thrombosis were (11.29 ± 1.38) days, (12.47 ± 1.73) days and 0, 0 in the experimental group, which were significantly lower than those in the control group (12.18 ± 1.47) days, (13.53 ± 1.62) days and 11.8%(4/34), 14.7%(5/34). The withdrawal success rate was 94.1%(32/34) in the experimental group, significantly higher than that in the control group 76.5% (26/34), the difference was statistically significant ( χ2=4.22, P<0.05). Conclusions:Grading pulmonary rehabilitation nursing can improve the respiratory function, shorten the time of mechanical ventilation and the length of ICU hospitalization, as well as reduce the occurrence of complicaitons.
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Objective:To evaluate and summarize the best evidence for early rehabilitation of adults with veno-venous extracorporeal membrane oxygenation (VV-ECMO).Methods:Evidence on early rehabilitation of adult VV-ECMO patients was searched by computer from 7 English literature databases [PubMed database, cumulative index to nursing and allied health literature (CINAHL), Embase database, Cochrane library database, UpToDate clinical consultant, BMJ best clinical practice, JBI database], 5 Chinese literature databases (China biomedical literature database, China Yimai Tong, China national knowledge infrastructure, Wanfang data, VIP database), 5 guideline networks [National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), China Guide Network] and 2 professional association websites [Extracorporeal Life Support Organization (ELSO), Chinese Association of Rehabilitation Medicine]. The search period is from January 2011 to December 2021. The appraisal of guidelines for research and evaluation Ⅱ (AGREE ) and JBI 2014 quality assessment tools were used to evaluate the quality of inclusion guidelines, systematic reviews, expert consensus and original studies, respectively, and to extract and summarize the best evidence for early rehabilitation of adults with VV-ECMO.Results:A total of 2 guidelines, 2 expert consensuses, 2 systematic reviews and 8 original studies [including 1 randomized controlled trial (RCT), 1 non-randomized controlled study, 3 cohort studies and 3 case reports] were included. The evidence was summarized from 9 aspects including the necessity of early rehabilitation, rehabilitation initiation time, rehabilitation location, pre-rehabilitation preparation, pre-rehabilitation assessment, rehabilitation method, rehabilitation frequency and duration, rehabilitation process monitoring and effect evaluation,and finally 24 pieces of the best evidence were summarized.Conclusion:Early rehabilitation of adults with VV-ECMO is safe and feasible. The summary of the best evidence can provide evidence-based guidance for clinical medical staff to reasonably carry out early rehabilitation.
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Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases, including exercise training, behavior change and self-management.It aims to improve the physical and psychological condition of people with chronic respiratory diseases and to promote the long-term adhe-rence to health-enhancing behaviors.Pulmonary rehabilitation has been extensively applied to adults with chronic respiratory diseases such as chronic obstructive pulmonary disease, and it also has been adopted for children with respiratory related diseases.Pulmonary rehabilitation strategies vary for different diseases.Individualized pulmonary rehabilitation programs should be made according to the underlying diseases of children.In this manuscript, the application of exercise training in children with asthma, cystic fibrosis, bronchiectasis, bronchopulmonary dysplasia, bronchiolitis obliterans, neuromuscular diseases complicated with respiratory problems and severe pneumonia were reviewed.
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Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases, including exercise training, behavior change and self-management.It aims to improve the physical and psychological condition of people with chronic respiratory diseases and to promote the long-term adhe-rence to health-enhancing behaviors.Pulmonary rehabilitation has been extensively applied to adults with chronic respiratory diseases such as chronic obstructive pulmonary disease, and it also has been adopted for children with respiratory related diseases.Pulmonary rehabilitation strategies vary for different diseases.Individualized pulmonary rehabilitation programs should be made according to the underlying diseases of children.In this manuscript, the application of exercise training in children with asthma, cystic fibrosis, bronchiectasis, bronchopulmonary dysplasia, bronchiolitis obliterans, neuromuscular diseases complicated with respiratory problems and severe pneumonia were reviewed.
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Objective:To investigate the effect of early external diaphragm pacing on the diaphragm function and prognosis of patients with mechanical ventilation.Methods:A total of 47 patients receiving invasive mechanical ventilation in the Emergency Intensive Care Unit of Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University) from October 2019 to July 2021 were selected and randomly divided into the treatment group ( n=23) and control group ( n=24). The patients in the control group received routine clinical treatment. On this basis, the treatment group received external diaphragm pacing treatment every day from the third day of mechanical ventilation until weaning, and was followed up to 30 days after discharge. The diaphragm thickness, diaphragm excursion, diaphragm thickening fraction, mechanical ventilation time, number of weaning failures, length of hospital stay and death toll were compared between the two groups. Results:Compared with the control group, the diaphragm thickness [(0.21±0.05) cm vs. (0.16±0.05) cm], diaphragm excursion [(1.38±0.37) cm vs. (1.11±0.48) cm], and diaphragm thickening fraction [26% (19%, 32%) vs. 18.5% (10.25%, 20%)] in the treatment group increased significantly (all P<0.05). The mechanical ventilation time was shorter in the treatment group [10 (7, 15) d vs. 13 (10.25, 19) d], and the difference was statistically significant ( P<0.05). There were no significant differences in the number of weaning failures (7 vs. 9), length of hospital stay [22 (15 , 30) d vs.. 24 (17.25, 34.25) d] and deaths (8 vs. 8) (all P>0.05). Conclusions:Early application of external diaphragm pacing can improve the diaphragm function of patients with mechanical ventilation, delay the decline in diaphragm function, increase diaphragm excursion and diaphragm thickening fraction, and shorten the mechanical ventilation time.
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Objective:To explore the application effect of early intervention of pulmonary rehabilitation management in emergency department-ward linkage under multi-disciplinary team (MDT) mode in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:Using convenient sampling method, 124 AECOPD patients admitted to Department of Emergency of Qilu Hospital of Shandong University (Qingdao) were selected as the study objects. According to the admission order, 62 patients admitted from March to October 2020 were taken as the control group, and 62 patients admitted from March to October 2021 were taken as the observation group. The control group was given routine treatment and rehabilitation guidance. On the basis of this, the observation group received the early lung rehabilitation management of emergency-ward linkage under MDT mode. The arterial oxygen saturation, lung function index (FEV 1, FEV 1%Pred, FEV 1/FVC), 6-minute walk test (evaluation only after intervention) and quality of life of patients were evaluated before and after intervention. Results:Finally, 60 patients in each group completed the study. After the intervention, the arterial oxygen saturation, the score of quality of life, 6-minute walk test and FEV 1, FEV 1%Pred, FEV 1/FVC of patients in observation group were 0.93 ± 0.04, (29.68 ± 4.87) points, (341.93 ± 46.55) m, and (1.86 ± 0.68) L, (66.13 ± 8.96)%, (68.2 ± 58.53)%, respectively. And in the control group, they were 0.91 ± 0.04, (35.83 ± 2.94) points, (268.75 ± 50.78) m, and (1.50 ± 0.66) L, (61.70 ± 7.16)%, (64.10 ± 8.42) %, respectively. The observation group was significantly better than the control group ( t values were -8.23 to 8.37, all P<0.01). Conclusions:Early intervention of pulmonary rehabilitation by emergency-ward linkage under MDT mod can effectively improve arterial oxygen saturation, pulmonary function, exercise ability and quality of life of patients with AECOPD.
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@#Coronavirus 19 disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This is a case of a previously healthy 61-year-old man who presented to the emergency department with progressive dyspnea and a confirmed COVID-19 test, who was critically ill with severe acute respiratory distress syndrome. The principles of pulmonary rehabilitation were implemented starting from the sixth hospital day (time of referral from the intensive care unit) until he was transferred to a non-COVID ward and discharged. The patient participated in six treatment sessions while admitted, with each session lasting nearly 30 minutes. His Barthel index score improved from 0 (total dependence) to 85/100 (modified independence), with improvements in pulmonary secretions, shortness of breath, rate of perceived exertion, muscle strength, and endurance. He was able to return to work after three months. The application of the principles of pulmonary rehabilitation for critically ill patients with severe COVID-19 helped improve the cardiopulmonary, cognitive, and functional aspects of the patient throughout the course of hospital admission and beyond discharge.
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COVID-19 , Intensive Care Units , RehabilitationABSTRACT
Pneumoconiosis is a disease mainly characterized by diffuse fibrosis of lung tissues, which often leads to various chronic respiratory complications/comorbidities. Pulmonary rehabilitation therapy for pneumoconiosis follows the basic principles of chronic health management, and the implementation of pulmonary rehabilitation therapy for pneumoconiosis should cover the whole course of pneumoconiosis. The Consensus described the evaluation methods for pulmonary rehabilitation, rehabilitation methods and principles of individualized rehabilitation plans, and rehabilitation management comprehensively and systematically. The Consensus aimed to guide and assist all levels of medical institutions, convalescent stations and relevant personnel, as well as patients with pneumoconiosis in engaging with lung rehabilitation, and combined with the evaluation results, to select befitting rehabilitation programs and properly conduct lung rehabilitation, so as to achieve the goals of alleviating the suffering of pneumoconiosis patients, delaying the progression of the disease, improving the quality of life and social participation, extending the life expectancy of patients, and finally achieving the survival goal of prolonging life with the disease.
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Objective This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. Design This is the protocol of a living systematic review. Data sources We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. Ethics and dissemination No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.