Effect of nurse-led, goal-directed lung physiotherapy on prognosis of patients with sepsis caused by Acinetobacter baumannii pulmonary infection

Muscle strength trajectories and outcomes in critically ill patients: A prospective multicentre cohort study

OBJECTIVES

To investigate the trajectories and determinants of muscle strength in ICU patients and their impact on 1-, 6-, and 12-month mortality outcomes.

DESIGN

Prospective multicenter cohort study.

SETTINGS

Ten ICUs across five tertiary hospitals in Fujian Province, China.

METHODS

Muscle strength was assessed using handgrip strength at three time points: ICU admission, ICU discharge, and hospital discharge. Group-based trajectory modeling was employed to identify muscle strength trajectories, while multinomial logistic analysis determined predictors based on baseline characteristics. Mortality outcomes were assessed using a Cox proportional hazards model adjusted by inverse probability of treatment weighting.

RESULTS

Among 317 patients, with 37 deaths within 12 months, three muscle strength trajectories were identified: Low-Level Stability (38.17 %), Medium-Level Improvement (47.00 %), and High-Level Improvement (14.83 %). Older age (≥65 years), female gender, prolonged mechanical ventilation, and lower fat-free mass were associated with a higher likelihood of being in the Low-Level Stability group. After adjustment, the Medium-Level Improvement group had a 0.067 times lower 1-month mortality risk (95 % CI: 0.005-0.825) compared to the Low-Level Stability group, with no significant differences at 6 or 12 months (P > 0.05).

CONCLUSIONS

Three distinct muscle strength trajectories were identified: Low-Level Stability, Medium-Level Improvement, and High-Level Improvement. Older age, female sex, prolonged mechanical ventilation, and lower fat-free mass were strongly associated with the Low-Level Stability group, which had higher 1-month mortality.

IMPLICATIONS FOR CLINICAL PRACTICE

Findings from this study underscore the importance of early identification of Low-Level Stability patients, particularly those who are older, female, require prolonged mechanical ventilation, or have reduced fat-free mass. Tailored early rehabilitation in these high-risk individuals may offer substantial clinical benefit.

Trajectory and determinants of intensive care unit-acquired weakness in critical illness: A multicentre, prospective, longitudinal study

BACKGROUND

Intensive care unit-acquired weakness (ICU-AW) is prevalent and adversely affects patient outcomes. Muscle strength progression and response to rehabilitation differ across ICU populations. However, the trajectories, determinants and prognoses of muscle strength changes remain unclear.

AIM

This study aimed to investigate the trajectory and determinants of ICU-AW in critical illness and its impact on 60-day postadmission mortality.

STUDY DESIGN

A multicentre prospective cohort study was conducted, involving critically ill patients from 10 ICUs across five tertiary hospitals in Fujian Province, China. Patients were evaluated using the Medical Research Council (MRC) scale at three time points: within 48 h of ICU admission or within 24 h of regaining consciousness (T1), within 24 h of ICU discharge (T2) and at the time of hospital discharge (T3). The latent class growth mixed model was utilized for data analysis, and multivariable logistic regression was employed to examine the determinants of muscle strength trajectories.

RESULTS

This study encompassed 343 patients from five tertiary hospitals. Three latent trajectory groups were identified: a low-level decline group (5.83%), a medium-level stability group (25.36%) and a high-level recovery group (68.81%). Multivariable logistic regression revealed that Charlson comorbidity index (CCI) and alcohol consumption significantly influenced the trajectory of muscle strength development in ICU patients (p < .05). The mortality rate at 60 days was significantly higher in both the low-level decline and medium-level stability groups compared with the high-level recovery groups (p < .05).

CONCLUSIONS

This study identified three muscle strength trajectories in ICU patients: low-level decline, medium-level stability and high-level recovery. CCI and alcohol consumption significantly influenced these trajectories. The lower 60-day mortality rate in the high-level recovery group underscores the need for early intervention and tailored care.

RELEVANCE TO CLINICAL PRACTICE

Developing targeted rehabilitation strategies for those at risk of low-level decline or medium-level stability group is challenging and may potentially improve recovery and outcomes.

Resistance training combined with β-hydroxy β-methylbutyrate for patients with critical illness: A four-arm, mixed-methods, feasibility randomised controlled trial

OBJECTIVES

This study aimed to assess the feasibility, safety, acceptability, and potential effectiveness of resistance training (RT) with or without β-Hydroxy β-Methylbutyrate (HMB) intervention program for ICU patients.

DESIGN

Open-label, parallel group, mixed method, randomized controlled trial.

SETTINGS

A tertiary general hospital in Fuzhou, China.

METHODS

Participants were randomly allocated to one of four groups. The RT group received supervised multilevel resistance training (RT) using elastic bands, administered by trained ICU nurses. The HMB group received an additional daily dose of 3.0 g HMB. The combination group underwent both interventions concurrently, while the control group received standard care. These interventions were implemented throughout the entire hospitalization period. Primary outcomes included feasibility indicators such as recruitment rate, enrollment rate, retention rate, and compliance rate. Secondary outcomes covered adverse events, acceptability (evaluated through questionnaires and qualitative interviews), and physical function. Quantitative analysis utilized a generalized estimation equation model, while qualitative analysis employed directed content analysis.

RESULTS

All feasibility indicators met predetermined criteria. Forty-eight patients were randomly assigned across four arms, achieving a 96% enrollment rate. Most patients adhered to the intervention until discharge, resulting in a 97.9% retention rate. Compliance rates for both RT and HMB interventions approached or exceeded 85%. No adverse events were reported. The intervention achieved 100% acceptability, with a prevailing expression of positive experiences and perception of appropriateness. The RT intervention shows potential improvement in physical function, while HMB does not.

CONCLUSIONS

Implementing nurse-led resistance training with elastic bands with or without HMB proved to be feasible and safe for ICU patients.

IMPLICATIONS FOR CLINICAL PRACTICE

A large-scale, multicenter clinical trials are imperative to definitively assess the impact of this intervention on functional outcomes in this population.

Effect of Improved Nursing Strategy on Prognosis of Immunosuppressed Patients With Pneumonia and Sepsis: A Prospective Cohort Study

Objectives: To investigate the effect of our improved nursing strategy on prognosis in immunosuppressed patients with pneumonia and sepsis. Methods: Immunosuppressed patients (absolute lymphocyte count <1000 cells/mm3) with pneumonia and sepsis were enrolled and divided into a control group and treatment group. The treatment group received the improved nursing strategy. The primary outcome in this study was 28-day mortality. Results: In accordance with the study criteria, 1019 patients were finally enrolled. Compared with patients in the control group, those in the treatment group had significantly fewer days on mechanical ventilation [5 (4, 7) versus 5 (4, 7) days, P = .03] and lower intensive care unit (ICU) mortality [21.1% (132 of 627) vs 28.8% (113 of 392); P = .005] and 28-day mortality [22.2% (139 of 627) vs 29.8% (117 of 392); P = .006]. The treatment group also had a shorter duration of ICU stay [9 (5, 15) vs 11 (6, 22) days, P = .0001] than the control group. The improved nursing strategy acted as an independent protective factor in 28-day mortality: odds ratio 0.645, 95% confidence interval: 0.449-0.927, P = .018. Conclusion: Our improved nursing strategy shortened the duration of mechanical ventilation and the ICU stay and decreased ICU mortality and 28-day mortality in immunosuppressed patients with pneumonia and sepsis. Trial registration: ChiCTR.org.cn, ChiCTR-ROC-17010750. Registered 28 February 2017.

Role of Intensified Lung Physiotherapy Bundle on the Occurrence of Pneumonia After Cardiac Surgery

Objective

The role of intensified lung physiotherapy bundle after cardiac surgery was investigated.

Methods

A before- and after-surgery comparison was conducted between the study from January 1, 2018 to December 31, 2019 (control group), when traditional lung physiotherapy bundle was used, and from January 1, 2020 to May 1, 2021 (study group), when the intensified bundle was used. The baseline data, clinical features, incidence of postoperative pneumonia, and prognoses of all the enrolled cardiac surgery patients were analyzed.

Results

In accordance with the study criteria, 358 patients were enrolled. The incidence rate of postoperative pneumonia was significantly lower in the study group than in the control group (14.2 vs. 22.7%, P = 0.037), as was in-hospital mortality (1.5 vs. 5.2%, P = 0.043). Patients receiving the intensified lung physiotherapy bundle had much shorter mechanical ventilation time (92 vs. 144 h, P < 0.0001), much shorter intensive care unit (ICU) stay (5 vs. 7 days, P < 0.001), and much shorter hospital stay (17 vs. 18.5 days, P = 0.022). The intensified lung physiotherapy bundle was an independent protective factor enabling the reduced occurrence of pneumonia (P = 0.007). On univariate analysis, this bundle significantly improved in-hospital mortality (P = 0.043).

Conclusions

Our intensified lung physiotherapy bundle potentially reduces the rate of postoperative pneumonia after cardiac surgery. This bundle might also be adopted as a suitable reference guide for the prevention of other postoperative pulmonary complications.