[The impact of ultrasound-based diaphragmatic targeted functional exercise bundle strategy on clinical outcomes of patients with acute exacerbation of chronic obstructive pulmonary disease combined with type II respiratory failure receiving mechanical ventilation].

OBJECTIVE

To explore the interventional effects of a targeted diaphragmatic function exercise bundle strategy, guided by ultrasound assessment, on nutritional status, diaphragmatic function, muscle strength, and hospital stay of mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by type II respiratory failure.

METHODS

A randomized controlled study was conducted. Patients with AECOPD complicated by type II respiratory failure who received mechanical ventilation in the Department of Critical Care Medicine, the Second Hospital of Tianjin Medical University from January to December 2024 were enrolled. Using a random number table, patients were divided into an experimental group and a control group. The control group received routine intensive care unit (ICU) treatment and nursing care. On the basis of routine care, the experimental group received a targeted diaphragmatic function exercise bundle strategy based on ultrasound assessment, including limb function exercises and respiratory function training. The duration and intensity of the exercises were adjusted according to the patient's vital signs, clinical condition, tolerance, and daily improvement in diaphragmatic function. The following indicators were compared between the two groups before the intervention and on the 7th day of intervention: nutritional indicators [albumin, total protein, hemoglobin, body mass index (BMI), Nutritional Risk Screening 2002 (NRS2002) score]; diaphragmatic function (diaphragmatic excursion, diaphragmatic thickness); blood gas analysis indicators (pH value, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, base excess, lactate, alveolar-arterial oxygen gradient); and muscle strength. The duration of mechanical ventilation, length of ICU stay, and total hospital stay were also compared between the two groups.

RESULTS

A total of 134 patients were finally enrolled, including 66 in the experimental group and 68 in the control group. There were no statistically significant differences in baseline data including gender, age, Acute Physiology and Chronic Health Evaluation II, nutritional indicators, blood gas analysis parameters, diaphragmatic excursion, diaphragmatic thickness, and muscle strength between the two groups (all P>0.05). Compared with before intervention, both groups showed varying degrees of improvement in diaphragmatic function indicators, blood gas analysis indicators, and muscle strength on the 7th day of intervention, but nutritional indicators decreased. On the 7th day of intervention, the experimental group had better nutritional indicators (albumin, total protein, hemoglobin, and BMI) than the control group [albumin (g/L): 27.49±3.78 vs. 26.03±3.76, total protein (g/L): 55.84±6.17 vs. 53.42±6.22, hemoglobin (g/L): 105.10±24.74 vs. 96.80±21.17, BMI (kg/m2): 24.84±2.55 vs. 24.12±1.13, all P<0.05]. The improvements in diaphragmatic excursion and diaphragmatic thickness were greater in the experimental group than in the control group [difference in diaphragmatic excursion before and after intervention (cm): 0.182±0.030 vs. 0.104±0.020; difference in diaphragmatic thickness before intervention and after intervention (cm): 0.023±0.004 vs. 0.014±0.002, both P<0.05], and muscle strength was enhanced in the experimental group compared with the control group (χ 2=21.860, P=0.001), whereas there were still no statistically significant differences in blood gas analysis indicators between the two groups (all P>0.05). Compared with the control group, the experimental group had a significantly shorter duration of mechanical ventilation [hours: 137.5 (90.8, 202.2) vs. 162.5 (92.5, 263.8)], shorter length of ICU stay [days: 9.0 (5.8, 14.5) vs. 11.0 (7.0, 18.0)], shorter total hospital stay [days: 12.0 (7.0, 20.0) vs. 17.0 (10.0, 23.5)], and a higher weaning success rate (89% vs. 76%), with all differences being statistically significant (all P<0.05).

CONCLUSIONS

Implementation of the targeted diaphragmatic function exercise bundle strategy based on ultrasound assessment can effectively improve nutritional status and diaphragmatic function, enhance muscle strength, and shorten the duration of mechanical ventilation and hospital stay in mechanically ventilated patients with AECOPD complicated by type II respiratory failure. It can serve as an effective adjunctive treatment for these patients.