Does Standard Physical Therapy Increase Quadriceps Strength in Chronically Ventilated Patients? A Pilot Study.
Does Standard Physical Therapy Increase Quadriceps Strength in Chronically Ventilated Patients? A Pilot Study.
复制标题
DOI：
10.1097/ccm.0000000000004544
复制
发表时间：
2020-11
影响因子：
8.8
通讯作者：
Callahan LA
中科院分区：
文献类型：
--
作者：
Supinski GS;Valentine EN;Netzel PF;Schroder EA;Wang L;Callahan LA
文本中提供了补充数字内容。物理治疗是机械通气患者的标准护理，但使用非意志客观测量没有证据表明物理治疗可以增加该人群的肌肉力量。本研究检验了这样的假设：在呼吸机脱机设施中提供的 2 周标准常规物理治疗将增强机械通气患者的股四头肌力量。前瞻性观察研究。呼吸机脱机装置。因未能脱离机械通气而从急症护理医院转院并正在按照设施工作人员规定接受物理治疗的患者。没有任何。我们采用了一种新颖的非意志客观技术，即股四头肌对股神经磁刺激产生抽搐力，以评估传统物理治疗前后两周的腿部力量。还记录了为患者提供的持续时间和具体锻炼。在一部分患者中，我们使用无线肌电图记录测量了肌肉激活强度。还评估了呼吸功能指数（最大吸气压产生和浅快呼吸指数）。患者对两周物理治疗的反应较差；平均而言，股四头肌抽搐下降了 –1.02±0.71 牛顿。物理治疗持续时间和特定运动形式都没有被确定对股四头肌抽搐有积极影响。肌电图记录表明，在训练过程中，肌肉激活很差。因此，治疗师花费大量时间进行几乎没有引起肌肉激活的练习。物理治疗并不能改善呼吸功能。在呼吸机脱机设施中提供的标准物理治疗未能改善大多数机械通气患者的股四头肌腿部力量。机械通气患者在物理治疗期间无法实现高水平的肌肉激活这一事实为物理治疗常常无效的原因提供了可能的解释。我们推测，使用增加运动过程中肌肉激活的新方法可能会改善机械通气患者对物理治疗的反应。
Supplemental Digital Content is available in the text. Physical therapy is standard care for mechanically ventilated patients, but there is no evidence, using nonvolitional, objective measurements, that physical therapy increases muscle strength in this population. The present study tested the hypothesis that 2 weeks of standard, conventional physical therapy provided at a ventilator weaning facility would increase quadriceps strength in mechanically ventilated patients. Prospective observational study. Ventilator weaning unit. Patients who were transferred from an acute care hospital because of failure to wean from mechanical ventilation and who were receiving physical therapy as prescribed by facility staff. None. We employed a novel, nonvolitional objective technique, quadriceps twitch force generation in response to femoral nerve magnetic stimulation, to assess leg strength before and after 2 weeks of conventional physical therapy. The duration and specific exercises provided to patients were also recorded. In a subset of patients, we measured muscle activation intensity using wireless electromyogram recordings. Indices of respiratory function (maximum inspiratory pressure generation and the rapid shallow breathing index) were also assessed. Patients’ responses to 2 weeks of physical therapy were poor; on average, quadriceps twitch fell by –1.02 ± 0.71 Newtons. Neither physical therapy duration nor specific forms of exercise were identified to positively impact quadriceps twitch. Electromyogram recordings indicated that during training, muscle activation was poor. Consequently, therapists spent substantial time performing exercises that elicited little muscle activation. Physical therapy did not improve respiratory function. Standard physical therapy delivered in a ventilator weaning facility failed to improve quadriceps leg strength in a majority of mechanically ventilated patients. The fact that mechanically ventilated patients fail to achieve high levels of muscle activation during physical therapy provides a potential explanation as to why physical therapy may often be ineffective. We speculate that use of novel methods which increase muscle activation during exercise may improve responses of mechanically ventilated patients to physical therapy.