Implementing Early Rehabilitation Strategies for Chronic Obstructive Pulmonary Disease (COPD) Patients Undergoing Mechanical Ventilation in the Intensive Care Unit

Abstract

BACKGROUND Patients afflicted with Chronic Obstructive Pulmonary Disease (COPD) frequently manifest acute respiratory failure (ARF), characterized by hypercapnia, hypoxia, malnutrition, muscle weakness, heightened work of breathing (WOB), recurrent acute exacerbations, reliance on mechanical ventilation (MV), and difficulties in the weaning phase. Early implementation of rehabilitation interventions holds promise in mitigating prolonged mechanical ventilation and consequently, reducing intensive care unit (ICU) morbidity and mortality. METHODOLOGY: A prospective study was undertaken involving COPD type 2 respiratory failure patients receiving MV in an ICU setting. Random assignment was employed to allocate patients to either the experimental or control groups. Both groups received chest physiotherapy, range-of-motion exercises, and standard medical and nursing care. The experimental group additionally underwent early active rehabilitation exercises, including limb strength training and progressive mobility tasks. Various parameters such as Mechanical ventilator duration, ICU length of stay (LOS), mortality, and occurrence of adverse events were documented. Group differences were analyzed using independent t-tests. RESULTS Among fifty-two patients, 33 were assigned in a random manner to each group using sealed envelopes. After withdrawals, 15 patients remained in each group. The experimental group had significantly shorter durations of mechanical ventilation (2.29 ± 0.611 vs 2.86 ± 0.663 days; 95% CI − 1.067 to − 0.076, t = − 2.371, P = 0.025) and ICU stay (7.667 ± 1.1751 vs 8.867 ± 1.6847 days; 95% CI − 2.2864 to − 0.1136, t = − 2.263, P = 0.032) compared to the control group. ICU mortality rates were similar between groups (1.933 ± 0.2582 vs 1.933 ± 0.2582; 95% CI − 0.1931 to 0.1931, t = 0.000, P = 1.000). The experimental group had a higher incidence of non-serious adverse events (0.667 ± 0.4880 vs 0.267 ± 0.4577 events; 95% CI − 0.0461 to − 0.7539, t = 2.316, P = 0.028), primarily transient physiological changes. CONCLUSION Engaging the early active rehabilitation exercises for mechanically ventilated COPD patients is practical and results in a reduction in MV duration, consequently shortening the ICU LOS.