QIN Qihong, LIU Jun. Application value of enhanced recovery management in difficult weaning[J]. Journal of Clinical Medicine in Practice, 2022, 26(21): 23-27. DOI: 10.7619/jcmp.20220785
Citation: QIN Qihong, LIU Jun. Application value of enhanced recovery management in difficult weaning[J]. Journal of Clinical Medicine in Practice, 2022, 26(21): 23-27. DOI: 10.7619/jcmp.20220785

Application value of enhanced recovery management in difficult weaning

More Information
  • Received Date: March 11, 2022
  • Available Online: November 17, 2022
  • Objective 

    To explore the feasibility and safety of enhanced recovery management in difficult weaning.

    Methods 

    A total of 40 patients with difficulty weaning in the ICU of Eastern Division of Suzhou Municipal Hospital from January 2020 to May 2021 were selected. They were divided into control group (n=20) and enhanced recovery group (n=20) according to whether accelerated rehabilitation management was implemented or not. The area and thickness of the left rectus femoris muscle were measured by ultrasound on the 1st, 3rd and 7th day of treatment. Diaphragm thickness was measured by ultrasound at 30 min after spontaneous breathing test (SBT) or when SBT failed and re-ventilated. Rapid shallow breathing index (RSBI) was measured by ventilator. Patients who met the clinical weaning criteria were weaned, and the duration of mechanical ventilation, length of ICU stay, and ICU cost were recorded. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of RSBI and diaphragmatic thickening fraction (DTF) on weaning outcomes in patients with difficult weaning.

    Results 

    The mechanical ventilation time and ICU stay time in the enhanced recovery group were significantly shorter than those in the control group (P < 0.05). The differences of left rectus femoris muscle area and left rectus femoris muscle thickness between 1 d and 3 d of treatment, between 1 d and 7 d of treatment in the enhanced recovery group were significantly lower than those in the control group (P < 0.01). The DTF of the control group was significantly lower than that of the enhanced recovery group, and RSBI was significantly higher than that of the enhanced recovery group (P < 0.05). The area under the curve (AUC) of RSBI and DTF were 0.714 and 0.687, respectively. When the optimal cut-off value of RSBI was 105 breaths/(min·L), the sensitivity and specificity of predicting weaning failure were 88.3% and 54.6%, respectively. When the cut-off value of DTF was 30.0%, the sensitivity and specificity were 71.2% and 84.7%, respectively.

    Conclusion 

    Enhanced recovery management can effectively shorten the duration of mechanical ventilation and hospital stay in ICU patients with difficulty weaning, and can effectively prevent ICU acquired weakness and diaphragmatic dysfunction. Ultrasonic monitoring DTF has certain guiding value for predicting difficult weaning.

  • [1]
    SELLARES J, FERRER M, CANO E, et al. Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU[J]. Intensive Care Med, 2011, 37(5): 775-784. doi: 10.1007/s00134-011-2179-3
    [2]
    HAWKINS R B, RAYMOND S L, STORTZ J A, et al. Chronic critical illness and the persistent inflammation, immunosuppression, and catabolism syndrome[J]. Front Immunol, 2018, 9: 1511. doi: 10.3389/fimmu.2018.01511
    [3]
    VARADHAN K K, LOBO D N, LJUNGQVIST O. Enhanced recovery after surgery: the future of improving surgical care[J]. Crit Care Clin, 2010, 26(3): 527-547.
    [4]
    中国加速康复外科专家组. 《中国加速康复外科围手术期管理专家共识(2016)》发布[J]. 中华医学信息导报, 2016(13): 8-13.
    [5]
    尤勇, 虞文魁. 重症患者加速康复策略[J]. 医学研究生学报, 2019, 32(11): 1121-1124. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB201911002.htm
    [6]
    JOVANOVIC G, JAKOVLJEVIC D K, LUKIC-ŠARKANOVIC M. Enhanced recovery in surgical intensive care: a review[J]. Front Med: Lausanne, 2018, 5: 256.
    [7]
    PANDHARIPANDE P P, ELY E W, ARORA R C, et al. The intensive care delirium research agenda: a multinational, interprofessional perspective[J]. Intensive Care Med, 2017, 43(9): 1329-1339.
    [8]
    LEVINE S, NGUYEN T, TAYLOR N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans[J]. N Engl J Med, 2008, 358(13): 1327-1335.
    [9]
    DEMOULE A, JUNG B, PRODANOVIC H, et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study[J]. Am J Respir Crit Care Med, 2013, 188(2): 213-219.
    [10]
    GOLIGHER E C, BROCHARD L J, REID W D, et al. Diaphragmatic myotrauma: a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure[J]. Lancet Respir Med, 2019, 7(1): 90-98.
    [11]
    BAPTISTELLA A R, SARMENTO F J, DA SILVA K R, et al. Predictive factors of weaning from mechanical ventilation and extubation outcome: a systematic review[J]. J Crit Care, 2018, 48: 56-62.
    [12]
    GOLIGHER E C, DRES M, FAN E, et al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes[J]. Am J Respir Crit Care Med, 2018, 197(2): 204-213.
    [13]
    SINDERBY C, BECK J, SPAHIJA J, et al. Voluntary activation of the human diaphragm in health and disease[J]. J Appl Physiol (1985), 1998, 85(6): 2146-2158.
  • Related Articles

    [1]LUO Hao, WANG Yongli, XU Jinbao, GUO Zhijia, ZHAO Pengfei. Prognostic value of Rotterdam CT score combined with serum soluble cluster of differentiation antigen 40 ligand and fibulin-5 for prognosis of patients with severe traumatic brain injury[J]. Journal of Clinical Medicine in Practice, 2024, 28(13): 52-57. DOI: 10.7619/jcmp.20240482
    [2]XIA Dexin, ZUO Junbo, YAN Yulan, ZHANG Zhenzhen, GAO Shengbao, BU Xuefeng. Effect of sarcopenia on early postoperative clinical prognosis of patients with gastric cancer[J]. Journal of Clinical Medicine in Practice, 2023, 27(9): 65-70. DOI: 10.7619/jcmp.20230242
    [3]ZHANG Yingjie, WANG Shibo, ZHU Jing, WANG Jing, YU Dawei. Expression of plasma exosomal microRNA-202-5p in patients with severe traumatic brain injury and its value in predicting prognosis[J]. Journal of Clinical Medicine in Practice, 2022, 26(19): 61-65. DOI: 10.7619/jcmp.20220746
    [4]WANG Wenyan. Influence of evidence-based nursing on complications of gynecological patients in ICU[J]. Journal of Clinical Medicine in Practice, 2015, (22): 91-93. DOI: 10.7619/jcmp.201522030
    [5]CHEN Junhong, YAO Qin, LI Guangqun. Influence of time and manner of pregnancy termination on prognosis and complications of mothers and infants in pregnant women with severe pregnancy-induced hypertensive syndrome[J]. Journal of Clinical Medicine in Practice, 2015, (9): 170-172. DOI: 10.7619/jcmp.201509058
    [6]LI Kai, ZHOU Jie, CHE Wanmin, SONG Limei, ZHAO Quanhua, DONG Tao. Influence of edaravone on hydrocephalus and prognosis of patients with moderate and severe traumatic brain injury[J]. Journal of Clinical Medicine in Practice, 2014, (16): 128-130. DOI: 10.7619/jcmp.201416041
    [7]ZHOU Li. Study of the effect of early promoting resuscitation nursing on the prognosis in patients with severe craniocerebral injury[J]. Journal of Clinical Medicine in Practice, 2014, (8): 99-101. DOI: 10.7619/jcmp.201408037
    [8]CHEN Xiaoyan, ZHONG Yueping. Observation on complications of nasal feeding in the patients with severe craniocerebral injury and related nursing[J]. Journal of Clinical Medicine in Practice, 2013, (10): 61-63. DOI: 10.7619/jcmp.201310023
    [9]HUANG Yuanzhi, HU Cuizhu, HUANG Zaiwen. Analysis of relevant risk factors and prognosis of hemorrhagic complications of cerebral infarction[J]. Journal of Clinical Medicine in Practice, 2013, (7): 33-35. DOI: 10.7619/jcmp.201307010
    [10]XU Rong-xiang. Study on treatment and prognosis of 60 cases of allergic purpura kidney complications type Ⅱ[J]. Journal of Clinical Medicine in Practice, 2011, (24): 132-133. DOI: 10.3969/j.issn.1672-2353.2011.24.049
  • Cited by

    Periodical cited type(2)

    1. 何君梅,李思宇,唐志红. 创伤性颅脑损伤的临床治疗进展. 中国临床医生杂志. 2025(01): 19-23 .
    2. 吴碧珠. 集束化护理干预对外伤性颅脑损伤患者负性情绪、生命质量及睡眠质量的影响. 世界睡眠医学杂志. 2023(08): 1896-1899 .

    Other cited types(0)

Catalog

    Article views (148) PDF downloads (14) Cited by(2)

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return