OBJECTIVE To explore the effect of comprehensive interventions to pulmonary rehabilitation on prevention of ventilator-associated pneumonia (VAP) in elderly patients undergoing long-term mechanical ventilation.
METHODS A total of 154 elderly patients (aged no less than 80 years old) who received long-term mechanical ventilation (no less than 21 days) in the Second Medical Center of Chinese PLA General Hospital from Nov. 2018 to Dec. 2024 were recruited as the research subjects and were randomly divided into the comprehensive intervention group with 77 cases (routine nursing plus comprehensive interventions to pulmonary rehabilitation) and the routine nursing group with 77 cases.
RESULTS The incidence of VAP was 12.31% in the comprehensive intervention group, 30.65% in the routine nursing group (P=0.009); the off-ventilator oxyhemoglobin saturation was (92.29±5.78)% in the comprehensive intervention group at the end of observation period, (88.84±4.70)% in the routine nursing group (P < 0.001); the diaphragmatic thickening ratio was (36.78±16.06)% in the comprehensive intervention group, (25.02±19.97)% in the routine nursing group (P < 0.001); the 24-hour expectoration volume was (94.68±26.65) ml in the comprehensive intervention group, (64.61±15.16) ml in the routine nursing group (P < 0.001); all the above indexes were improved. The result of multivariate logistic regression analysis showed that no interventions to pulmonary rehabilitation (OR=2.763, 95%CI: 1.061 to 7.195) and mechanical ventilation (OR=1.107, 95%CI: 1.033 to 1.186) were the risk factors for VAP (P < 0.05).
CONCLUSIONS The comprehensive interventions to pulmonary rehabilitation can remarkably improve the respiratory function of the elderly patients undergoing mechanical ventilation and reduce the incidence of VAP. The extension of mechanical ventilation may increase the risk of VAP.
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