Diaphragm ultrasound monitoring and sequential muscle training for weaning elderly COPD patients from mechanical ventilation.

Abstract

Background: Weaning elderly patients with chronic obstructive pulmonary disease (COPD) from mechanical ventilation is a complex and critical process. This study aims to assess the efficacy of ultrasound monitoring of diaphragm function combined with sequential muscle training in predicting and facilitating this weaning process.

Methods: In this randomized controlled trial, 100 elderly COPD patients on mechanical ventilation were divided into two groups: an intervention group receiving sequential muscle training and a control group with standard care. The training regimen targeted the diaphragm and accessory respiratory muscles. Diaphragmatic ultrasonography was performed on participants to measure the right diaphragm excursion (DE), contraction velocity, diaphragm thickening fraction (DTF), and respiratory rate (RR)/DTF.

Results: The intervention group demonstrated significant improvements in diaphragmatic function, with mean DE increasing to 2.40 ± 0.46 cm, CV to 1.99 ± 0.37 cm/s, DTF to 0.35 ± 0.05, and RR/DTF 61.0 ± 8.0, compared to the control group's DE of 2.06 ± 0.46 cm, CV of 1.54 ± 0.44 cm/s, DTF of 0.30 ± 0.06, and RR/DTF 55.7 ± 7.3. Notably, the weaning success rate was higher in the intervention group (58.33%) compared to the control group (43.75%).

Conclusion: Sequential muscle training, alongside standard care, significantly improves diaphragmatic function and increases weaning success rates in elderly COPD patients. These findings suggest that incorporating targeted respiratory muscle training into the care regimen could facilitate the weaning process, highlighting the potential for improving patient outcomes in critical care settings.