Effect of cough assist on the effect of sputum excretion in patients with cough and weakness after extubation / 中国实用护理杂志

ABSTRACT

Objective@#To investigate the effect of cough assist on sputum excretion and the outcome of withdrawal of mechanical ventilation after mechanically ventilated chronic obstructive pulmonary disease (COPD) patients with cough weakness.@*Methods@#From January 2017 to December 2018, 74 patients with cough and weakness COPD after extubation of mechanical ventilation in the Department of Respiratory Critical Care Medicine of Hunan Provincial People's Hospital were divided into control group(n=37) and observation group (n=37) according to the random number table method. The patients in the control group were treated routinely after weaning and extubation, and the observation group was treated with cough assist after withdrawal of mechanical ventilation and extubation on the basis of the control group. The differences in drainage effect, blood gas index, reintubation rate and early prognosis index between the two groups were compared.@*Results@#After the intervention treatment, the first active sputum excretion and the total sputum volume on the first day were (5.6±3.4) ml and (33.1±5.2) ml in the observationgroup, and (4.2 ±2.0) ml and (29.1±7.4) ml in the control group, the difference was statistically significant (t=-2.10, 2.875, P<0.05). The number of significant cases of respiratory sound improvement in the observation group and the control group was 21 and 14 cases, respectively, and the difference between the two groups was statistically significant (Z=-1.974, P < 0.05). The oxygen partial pressure (PaO2) and oxygenation index (PaO2/FiO2) carbon dioxide partial pressure (PaCO2) values of the observation group were (80.0±8.4), (345.9±19.2), (46.7±6.6)mmHg, and (74.8±9.1), (310.7±21.9), (50.9±7.1)mmHg in the control group. The difference was statistically significant (t=-2.504,-2.710, 2.579, all P<0.05). The reintubation rate, noninvasive ventilation time, and hospitalization days after the initial extubation in the observation group were as follows: 5.6%(2/36), (64.1±18.9)h, (6.0±1.7)d, and 22.2%(8/36), (76.7±15.3)h, (7.2±2.8)d in the control group. The difference was statistically significant (χ2=4.181, t=2.528, 2.438, all P<0.05). The non-invasive ventilation rate within 72h in the observation group and the control group were 63.9% (23/36) and 75.0% (27/36), the difference was not statistically significant (χ2=0.222, P>0.05).@*Conclusions@#The application of cough assist in RICU patients with cough weakness after extubation by mechanical ventilation can improve the expectoration efficiency of cough, improve oxygenation, reduce carbon dioxide retention, reduce the rate of re-intubation, shorten the time of noninvasive ventilation and hospitalization after extubation, and improve the curative effect.