Application of nurse-led chest physiotherapy guided by lung ultrasound in mechanically ventilated patients

YANG Na'na; ZENG Hui; ZHOU Jing; WAN Jie; GAO Fei; CHEN Fang; CHEN Deyou

doi:10.12102/j.issn.1009-6493.2024.09.010

Abstract：Objective:To analyze the application effect of nurse-led chest-lung physiotherapy(CPT)guided by lung ultrasound in patients with invasive mechanical ventilation.Method:A total of 70 adult critically ill patients with invasive mechanical ventilation time≥48 h admitted to the intensive care unit(ICU)of a tertiary grade A hospital in Zunyi from June to December 2021 were selected and divided into study group(29 cases)and control group(31 cases)according to the random number table method.The control group was treated with conventional CPT,the study group implemented target-oriented CPT according to the results of lung ultrasound exploration.The lung ultrasound score,respiratory function,daily sputum volume,oxygenation index(PaO2/FiO2),invasive mechanical ventilation-related complications(VAP,atelectasis,DVT)and the incidence of adverse transport events were observed before and after intervention in the two groups.The time of invasive mechanical ventilation and the total length of stay in ICU after intervention were recorded in the two groups.Results:After excluding 10 patients,29 patients were included in the study group and 31 patients were included in the control group.The lung ultrasound scores of the two groups showed a downward trend after intervention,and the study group was lower than the control group at 3-7 days of intervention(P＜0.05).The tidal volume of the two groups increased after intervention,and the tidal volume of the study group was higher than that of the control group(P＜0.05).The peak airway pressure of the two groups after intervention was lower than that before intervention(P＜0.05).The daily sputum volume of the study group was significantly higher than that of the control group(P＜0.05).The oxygenation index of the two groups after intervention was improved compared with that before intervention,and the study group was higher than the control group at 3-7days after intervention(P＜0.05).The time of invasive mechanical ventilation,the total length of ICU stay,the total incidence of invasive mechanical ventilation-related complications and transport adverse events in the study group were better than those in the control group(P＜0.05).Conclusion:The implementation of nurse-led CPT treatment under the guidance of lung ultrasound can help patients with invasive mechanical ventilation to clear lower respiratory tract secretions,promote airway sputum excretion,improve lung ventilation function,reduce the incidence of complications related to invasive mechanical ventilation and adverse transport events,and shorten the time of invasive mechanical ventilation and ICU stay.