Authors: (including presenting author): :
FONG SM, (Msc Nurs HKU,RN) MOK KFV, (Msc Social Science HKPU,RNAPN)
Pun WMM, (Msc Nurs HKU, PsyD Clinical Psychology)
Affiliation: :
FONG SM, Hospital Authority KCC QEH
MOK KFV, Hospital Authority KCC QEH
Pun WMM, Associate Director, Master of Science in Nursing Hong Kong University
Keyword 1: :
Evidence-based guideline
Keyword 2: :
Early Rehabilitation Programme
Keyword 3: :
Duration of Mechanical Ventilation
Introduction: :
This study proposes an evidence-based guideline on implementing an early rehabilitation program for reducing the duration of mechanical ventilation in intubated patients in the medical specialty. Given the significant risks and complications associated with prolonged mechanical ventilation, early rehabilitation programme has emerged as a crucial intervention to enhance patient outcomes. There are no evidence-based guidelines in the target clinical setting, hence developing an evidence-based guideline would help to standardize the practice to ensure effective delivery of the intervention. Patient outcomes can be improved and healthcare costs can be potentially saved. Results indicate that the early rehabilitation programme is effective in reducing the duration of mechanical ventilation with statistical significance. In addition, the length of intensive bed stay is shortened. Hence, the incidence of related complications can be prevented, and overall recovery can be improved by the implementation of the early rehabilitation programme.
Objectives: :
The effectiveness of an evidence-based Early Rehabilitation Programme with main outcome measures of the study include (1) mechanical ventilator days of intubated cases. (2) the number of days in the medical specialty unit. (3) incident rate of unplanned extubation.
Methodology: :
Study Design: A Pilot Study with quasi-experiment method was used. From 1st October 2024 to 5th January 2025, 29 patients(n=29) fulfilled the inclusion criteria for the study and were recruited. Main outcome measures of the study include (1) mechanical ventilator days of intubated cases. (2) the number of days in the medical specialty unit. (3) incident rate of unplanned extubation. Instruments: Based on (Dong et al., 2021), the ERP was structured into six levels: Level 0 (only for unconscious patients), frequent turning every 2 hours; Level 1-2, maintaining joint range of motion and placing normal limb position besides turning for patients who could sit up for at least 20 min 3 times a day; Level 3, similar to level 2, but sitting on the edge of bed for patients who could perform upper-limb anti-gravity training; Level 4, similar to level 3, but standing up or sitting in a chair for at least 20 min a day for patients who could perform lower-limb anti-gravity training; Level 5, patients actively moved from the bed and walked at bedside. Levels 1-5 were suitable for conscious patients, while Levels 1-3 were for patients with tracheal intubation and Level 3-5 were for those with tracheostomy. Different levels of the rehabilitation programme were delivered to patients according to their physical and psychological conditions.
Result & Outcome: :
(1) Comparison between the intervention group and control group was made. A reduced duration of mechanical ventilation (MV) and the results were statistically significant. The mean difference of (MV) days was -1.7 (p = 0.005) (2) The length of medical specialty unit stay was reduced but the result was not statistically significant, with a mean difference of -1.12 days (p = 0.684). (3) There is a decreasing trend of having unexpected extubation rate after the implementation of the ERP (16.7% in the Conventional group and 10.3% in the interventional experimental group; P = 0.48).
