Application of airway clearance program based on lung ultrasound in patients with mechanical ventilation in ICU

doi:10.3761/j.issn.0254-1769.2023.09.008

Abstract

Abstract:

Objective To investigate the application effect of airway clearance program based on lung ultrasound in patients with mechanical ventilation in ICU. Methods A total of 106 mechanical ventilation patients admitted to the ICU of a tertiary A hospital in Hefei from January 2021 to June 2022 were selected by objective sampling method，and they were divided into an experimental group and a control group according to random number table method. The control group was given routine airway clearance program and the intervention group was given airway clearance program based on lung ultrasound. Pulmonary ultrasound scores，oxygenation index，diaphragm function and mechanical ventilation duration were compared between the 2 groups at the first，third and fifth days of intervention. Results A total of 123 cases were included in this study，among which 17 cases were excluded due to automatic withdrawal of less than 5 days in ICU. A total of 106 cases were finally included，including 56 cases in the experimental group and 50 cases in the control group. The results of repeated measurement analysis of variance showed that the pulmonary ultrasound score，oxygenation index， diaphragm thickness and thickness variation rate had statistical significance between groups， interaction and time effects（P<0.05）. There was no statistical significance in the mechanical ventilation time between the 2 groups（P=0.902）. Conclusion Airway clearance technique based on lung ultrasound can improve the oxygenation status and enhance the diaphragm function.

Key words: Ultrasonography, Airway Management, Respiration, Artificial, Intensive Care Units, Nursing Care

摘要：

目的探讨基于肺部超声的气道廓清方案在ICU机械通气患者中的应用效果。方法采用目的抽样法，选取2021年1月—2022年6月入住合肥市某三级甲等综合医院ICU的机械通气患者，根据随机数字表法分为试验组和对照组。试验组实施基于肺部超声的气道廓清方案，对照组实施常规的气道廓清方案。比较干预第1、3、5天，两组肺部超声评分、氧合指数、膈肌功能情况及机械通气时间的差异。结果共纳入研究对象123例，其中17例因自动退出或在ICU入住未满5 d给予剔除，最终纳入106例，试验组56例，对照组50例。重复测量方差分析结果显示，两组肺部超声评分、氧合指数、膈肌运动幅度及膈肌厚度变异率的时间与组间存在交互效应（P<0.05）。两组机械通气时间比较，差异无统计学意义（P=0.902）。结论基于肺部超声的气道廓清方案有助于改善患者氧合状况，增强膈肌功能。

关键词: 超声检查, 气道管理, 呼吸, 人工, 重症监护病房, 护理

NI Xiumei, XU Fengling, CHEN Hao, GONG Juan, ZHANG Chong, WANG Cui, LI Baoqin, HU Shaohua. Application of airway clearance program based on lung ultrasound in patients with mechanical ventilation in ICU[J]. Chinese Journal of Nursing, 2023, 58(9): 1076-1081.

倪秀梅, 徐凤玲, 陈浩, 宫娟, 章翀, 王翠, 李宝芹, 胡少华. 基于肺部超声的气道廓清方案在ICU机械通气患者中的应用[J]. 中华护理杂志, 2023, 58(9): 1076-1081.

Figures/Tables 6

Figure 1 Common signs of ultrasound examination of the lung

Table 1 The program of airway clearance technique based on lung ultrasound in patients with mechanical ventilation in ICU

Table 2 Baseline information of participants in 2 groups（n=106）

Table 3 Comparison of pulmonary ultrasound scores before and after intervention between the 2 groups（score，$\bar{x}±s$）

Table 4 Comparison of oxygenation index before and after intervention between the 2 groups（mmHg，$\bar{x}±s$）

Table 5 Comparison of diaphragmatic motion amplitude and variation rate of diaphragm thickness before and after intervention between the 2 groups （$\bar{x}±s$）

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