Supported Arm Training in Patients Recently Weaned From Mechanical Ventilation

Porta, Roberto; Vitacca, Michele; Gilè, L. S.; Clini, Enrico; Bianchi, Luca; Zanotti, E; Ambrosino, Nicolino

doi:10.1378/chest.128.4.2511

Cited by 104 publications

(99 citation statements)

References 34 publications

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“…[16][17][18][19][20][21][22] Most studies, including ours, have focused on mixed diseases, but 3 were performed on subjects with COPD alone. [16][17][18] In this severely ill subject subgroup, rehabilitation programs, physiotherapy, and inspiratory muscle training have already been shown to be safe [20][21][22] and capable of improving dyspnea, 16,17 oxygen saturation, 18 respiratory muscle strength, 16,17,19 upper and lower limb muscle strength, [17][18][19] exercise tolerance, 16,17,19,21,22 and activities of daily life functional scores, 14,20,21 and of decreasing hospital stay 16,18 and weaning time. 20 Clini et al 21 showed that most PMV subjects can benefit from a comprehensive rehabilitation program, suggesting that the degree of improvement of functional disability is associated with survival and weaning success rates.…”

Section: Discussionmentioning

confidence: 99%

“…3,11,12 In particular, patients may receive a prompt and dedicated physiotherapy rehabilitation program in chronic ventilator facilities, 1,3,13 and transfer from an ICU to a chronic ventilator facility substantially improved patients' ambulation and activities of daily life irrespective of the underlying pathophysiology, avoiding unnecessary immobilization 14 . To date, the role of comprehensive rehabilitation in critically ill adults still remains controversial 13 or not fully established 15 : patients who have survived a recent acute respiratory failure (ARF) event can benefit from an individually tailored physiotherapy rehabilitation program that improves clinical indices, respiratory and peripheral muscle strength, activities of daily life, exercise tolerance, and disability scores. 14,[16][17][18][19][20][21][22][23][24] Once the precipitating cause of the ARF episode has been solved, these chronically ill patients still require care due to their huge motor disabilities, clinical dependence (oxygen, mechanical ventilation, nutritional, and communication device needs), and nursing necessities, 3 which the care team (physiotherapist, doctor, and nurse) must measure to better guide the daily care of the patient. No study has been performed with a large patient sample to investigate patient needs with these 3 different perspectives combined.…”

Section: Introductionmentioning

confidence: 99%

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Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Vitacca¹,

Paneroni²,

Peroni

et al. 2014

Respir Care

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BACKGROUND:The aim of this study was to analyze the effects of a multidisciplinary program carried out in a chronic ventilator facility on disability, autonomy, and nursing needs of patients after a prolonged ICU stay. Secondary outcome measures were survival, weaning rate, chronic ventilator facility stay, and discharge destination. METHODS: Multidisciplinary assessment, clinical stabilization, weaning attempts, and a new Disabled Patients Autonomy Planning tool to assess daily care needs were investigated in 240 subjects in a chronic ventilator facility (52 subjects after cardiovascular surgery, 60 subjects with acute respiratory failure, 71 subjects with COPD, and 57 subjects with neurological disease). RESULTS: At admission, nursing needs, disability, and autonomy differed according to diagnosis (P < .001); weaned subjects had greater nursing needs (P < .001) and disability (P ‫؍‬ .0014) than unweaned subjects. During the stay, 13.8% of the subjects died irrespective of diagnosis (P ‫؍‬ .12); 47% (P < .001) were weaned with significant differences (P <.007) by diagnosis. In the 207 surviving subjects, nursing needs increased as disability increased (r ‫؍‬ 0.59, P < .001) and autonomy decreased (r ‫؍‬ ؊0.66, P < .001); disability and autonomy were interrelated (r ‫؍‬ 0.61, P < .001). Oxygen saturation, hypercapnia, dyspnea, disability, autonomy, and nursing needs significantly improved (all, P < .001). Fifty-nine percent of the subjects were discharged home. Subjects discharged to nursing homes presented mainly neurological diseases, being more disabled and less autonomous, with higher nursing needs (all, P < .04). Mechanical ventilation use and tracheostomy increased the probability of being discharged to a nursing home (odds ratio [OR] of 1.84, P ‫؍‬ .04; OR 2.47, P ‫؍‬ .003, respectively). Mortality was higher in subjects who were ventilated (OR 8.44, P < .001), male (OR 2.64, P ‫؍‬ .01), elderly (P < .001), or malnourished (P ‫؍‬ .01) and in subjects with low autonomy (P < .001), greater nursing needs (P ‫؍‬ .002), and more severe disabilities (P ‫؍‬ .04). CONCLUSIONS: A specialized tailored multidisciplinary program in subjects after an ICU stay contributed to recovery from disability, autonomy, and fewer nursing needs irrespective of diagnosis. Subjects discharged to a nursing home were the most severely disabled.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Vitacca¹,

Paneroni²,

Peroni

et al. 2014

Respir Care

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show abstract

“…Additionally, COPD patients in the ICU benefit from PR [25,26]. A subgroup of very impaired, deconditioned, patients receiving long-term ventilation responded to whole-body and respiratory muscle training in terms of improving strength, weaning outcome and functional status [27].…”

Section: Rehabilitationmentioning

confidence: 99%

Nonpharmacological treatment and relief of symptoms in COPD

Clini

Ambrosino²

2008

European Respiratory Journal

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Evidence-based guidelines for chronic obstructive pulmonary disease (COPD) have recently been developed.Nonpharmacological treatments have evolved rapidly as an essential part of COPD therapy. They are especially important as complementary interventions in severe or very severe disease, when there is loss in function, a reduction in quality of life and when psychological impairments further complicate the disease.The present article discusses the most used nonpharmacological treatments for severe COPD patients (rehabilitation, long-term oxygen therapy, surgery, noninvasive positive pressure ventilation and supportive nutrition) and their evidence-based usefulness in promoting strategies that relieve symptoms.All of these interventions are used during end-stage disease, to promote self-efficacy, relieve symptoms and prevent further deterioration. These therapeutic options support physicians and allied professionals in improving symptom management for their patients.

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“…Two of the studies, Porta et al (25) and Vitacca et al, (26) used an upper limbs cycloergometer for cardio-respiratory ability evaluation and treatment. The incremental test, which is symptom-limited, i.e., addition of a load per minute and the patient lead to exhaustion, only stopped before this threshold if heart rate reached the limit, or electrocardiogram changes were seen.…”

Section: Resultsmentioning

confidence: 99%

“…In the Porta et al (25) study, the upper limbs cycloergometer was added to kinesiotherapy in the intervention group for 20 minutes daily for 15 days , with 2.5 W/day increases/reductions according to the modified Borg scale and rest pause. The intervention group had a significant improvement versus the control group.…”

Section: Resultsmentioning

confidence: 99%