Pulmonary Disease
Conditions
Brief summary
Influence of early standing training on ICU patients
Detailed description
Objective: To study the effect of early standing training on ICU patients.Background: Early severe rehabilitation is of great significance for patients, which can help patients withdraw from mechanical ventilation as soon as possible, improve pulmonary ventilation, and promote early walking.However, patients on mechanical ventilation are more prone to delirium, muscle weakness, ventilator dependence and other problems. Early standing training can significantly improve patients' lower limb muscle strength, improve diaphragm function, improve the prognosis of patients, and reduce the length of hospital stay.Methods: selecting stable hemodynamics in ICU patients with mechanical ventilation, randomly divided into two groups, a group of routine rehabilitation training, another group stand for regular rehabilitation and early training, with the aid of electric beds, on the first day of patients, to evaluate the seventh day, the 14th day, and collect the basic information for patients and strength assessment, blood gas analysis, the diaphragm of the bed and ultrasound and muscle ultrasound, and record the patient's mortality within 28 days, the incidence of delirium, decannulation rate, etc., recorded in patients with mechanical ventilation time and the time required to walk independently and ICU stay time.
Interventions
BEHAVIORALIntensive rehabilitation
Early standing training and routine rehabilitation
Sponsors
Chinese PLA General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* The age is ≥ 18 years old; * the hemodynamics is stable; * 50 \< heart rate \< 120 beats / min ; * 90 \< systolic blood pressure \< 200mmHg ; * 55 \< mean arterial pressure \< 120mmHg; * do not increase the dose of pressor drugs for at least 2 hours; * intracranial pressure is stable and there are no seizures within 24 hours; * the respiratory state is stable; * the patient's finger pulse oxygen saturation ≥ 88%; * Oxygen concentration less than 60%； * Terminal positive expiratory pressure\<12cmH2O； * 10 \< respiratory frequency \< 35 beats / min.
Exclusion criteria
* Pregnancy; * acute cardio-cerebrovascular events; * spinal or limb fractures; * active bleeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Thickness of tibialis anterior muscle | day 1 | The thicker the muscle, the better |
| Diaphragm thickness at end of breath | day 1 | Normal adults are 0.15cm |
| Diaphragm thickness at end of inhalation | day 1 | Normal adults are 0.28cm |
| Diaphragmatic thickness variation rate | day 1 | Less than 20% have diaphragmatic dysfunction |
| E-T index | day 1 | Product of inspiratory time and diaphragmatic mobility,The higher the extubation success rate, the higher the extubation success rate. |
| Timed Inspiration | day 1 | Normal adults are 1s |
| Rectus femoris thickness | day 1 | The thicker the muscle, the better |
| Medical Research Council | day 1 | Muscle strength assessment of ICU patients，Out of 60 points，Less than 48 points had acquired muscle weakness in the ICU. |
| Berg Balance Scale | day 1 | Balance grade score,The highest 56 points,The higher the score, the better the balance. |
| FIM Function Independent Scale | day 1 | Functional independence assessment,The lowest score is 18 and the highest is 126,The higher the score, the more independent it is. |
| Holden walk classification | day 1 | Levels 0 to 5,The higher the grade, the better the ability to walk |
| arterial blood gas analysis | day 1 | PH,normal range 7.35-7.45 |
| partial pressure of carbon dioxide | day 1 | normal range 35-45 mmHg |
| oxygenation index | day 1 | Normal adults are 400,the higher，the better |
| lactic acid | day 1 | normal range 0.5-1.6mmol/L |
| Diaphragmatic movement | day 1 | The distance the diaphragm moves downward during inhalation,Normal adults are 1.4cm. |
| Diaphragm contraction rate | day 1 | Normal adults are 1.3cm/s |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| icu length of stay | three months | icu length of stay |
| Time required for independent walking | three months | Time required for independent walking |
| delirium | 28 days | Confusion Assessment Method of the Intensive Care Unit. Positive is delirium. |
| mortality | 28 days | mortality |
| reintubation | 28 days | Note whether intubation was performed within 28 days. |
| Mechanical ventilation time | three months | Mechanical ventilation time |
Contacts
Primary ContactZhao Ying
Outcome results
None listed