Arm Exercise Training on Patient Care Improvement Program from

Empirical Ventilator

PAO-NA Lin, RN1,.CHING-YI Lee, RN, MSN 2,* , WEN-HUI Lin, RN. , WEI-HUA Hsu , Dr.

1Nursing Department, Hsinchu Mackay Memorial Hospital, Hsinchu , Taiwan 2* Nursing Department, Hsinchu Mackay Memorial Hospital, Hsinchu , Taiwan

Background. Critically ill patients due to endotracheal intubation ventilator, through a stable condition after weaning started training, but found that in the final stages of weaning patients often fail,

because the main cause of long-term ventilator-dependent respiratory muscle weakness. There is literature that respiratory muscle training can promote exercise tolerance, respiratory muscle

endurance so that the quality of life improved.

Purpose. By empirical steps to implement the plan of care measures weaning and shorten patient ventilator time, and help patients successfully weaned from the ventilator, and thus enhance the

quality of care for patients.

Methods.

Clinical Question: For long-term use of respirators patient care should be given to the upper arm exercise training measures?

Clinical bottom line

Arm movement training purposes: to enhance ventilation efficiency, reduce dyspnea, to avoid the occurrence of acute exacerbations or complications, increased arm exercise

capacity, ease anxiety and frustration, increase self-care capacity, improve quality of life, reduce mortality and prolong life and shorter hospital stay (Kyung & Chin, 2007; O'Brien,

Geddes, Reid, Brooks, & Crowe, 2008). Arm movement is more laborious than the lower limb movements, breathing training with arm movement can effectively promote the

recovery of lung function (Wang, Qiu & Party, 2006). The study also pointed out that the center of patient care from a respirator during the early arm strengthening exercise training

provided to promote functional repair of different muscle groups, improve exercise tolerance and difficulty breathing discomfort. (Hopkins, 2010 & Porta et al, 2005)

P

I

C

O

Mechanical ventilation patient

Arm exercise training plus

general physiotherapy

Physiotherapy

adjust ventilator mode

1.Hospitalization days

2.Used mechanical ventilator days

3.Medical Expenses

4.Rapid shallow breating index

PICO Question

Data Sources: PubMed 1 Articles

Data Selection

Search Up To Date, Cochrane Database, Ovid medline, Trip database, Pub Med,

CEPS and other databases. Find a 1 literature relevancy to the theme .

Main Resulis(Critical Apprasal)

Ciation’s Study objecti and Design Measurements and results

Supported Arm Training in Patients

Recently Weaned From

Mechanical Ventilation

Roberto Porta, MD; Michele

Vitacca, MD; Lucia Sonia Gile,

MD; Enrico Clini, MD, FCCP; Luca

Bianchi, MD; Ercole Zanotti, MD;

Nicolino Ambrosino, MD, FCCP

Chest. 2005;128(4):2511-2520.

Study objectives: To evaluate the

effects of early exercise training in

patients recovering from acute

respiratory failure needing

mechanical ventilation (MV).

Design: Prospective, randomized,

and controlled study.

Setting: Three respiratory

intermediate ICUs (RIICUs).

Patients: Of 228 patients admitted

to an RIICU, 66 patients weaned

from MV from > 48 to < 96 h were

considered eligible and enrolled in

the study.

Twenty-five patients in each group completed the

protocol. Group 1 showed a greater improvement in

exercise capacity, as assessed by an arm incremental test

(IT) [p = 0.003] and an endurance test (ET) [p = 0.021],

compared to group 2. Posttraining maximal inspiratory

pressure (MIP) significantly improved in both groups (p <

0.001 and p = 0.003 in groups 1 and 2 respectively; not

significant). IT isoworkload dyspnea improved

significantly in both groups (p = 0.005 and p = 0.009 in

groups 1 and 2, respectively; not significant between

groups), whereas IT isoworkload peripheral muscle

fatigue (p < 0.001), ET isotime dyspnea (p < 0.01), and ET

isotime muscular fatigue (p < 0.005) improved

significantly in group 1 but not in group 2. IT improvers

(χ2 = 0.004) and ET improvers (χ2 = 0.047) were more

frequently observed in group 1 than in group 2. Baseline

MIP could discriminate for IT (p = 0.013; odds ratio [OR],

1.116) and ET improvers (p = 0.022; OR, 1.067).

Intervention: Sixty-six patients were randomized to either supported arm exercise training plus general physiotherapy (gPT) [group 1,

32 patients] or to gPT alone (group 2, 34 patients).

Conclusion: Early upper-limb exercise training is feasible in RIICU patients recently weaned from MV and can enhance the effects of

gPT. Baseline inspiratory muscle function is related to exercise capacity improvement.

Table .Mean Changes in Exercise, Functional, and Dyspnea Parameters After PRP in Both Groups

Variables Group 1 Group 2

Mean (95% CI) Differences in Changes

Between Groups

P Value

ΔWatt IT, W 7.3 2.6 4.7 (1.69 to 7.75) 0.003*

ΔBorg scale dyspnea IT − 1.24 − 1.5 0.26 (−0.97 to 1.49) 0.59

ΔBorg scale muscle fatigue IT

− 2.2 − 0.87 − 1.35 (−2.77 to 0.07) 0.091*

ΔTime ET, min 8 4 4.12 (0.68 to 7.56) 0.021*

ΔBorg scale dyspnea ET − 2.12 − 0.66 − 1.46 (− 2.93 to 0.014) 0.07*

ΔBorg scale muscle fatigue ET

− 2.24 − 0.7 − 1.54 (− 3.05 to − 0.33) 0.056*

ΔMIP, cm H2O 9.8 4.8 4.9 (− 0.62 to 10.6) 0.08 *

Trial profile. Group 1 (study group) = gPT plus SAEx; group 2 (control group) = gPT only.