Implementation of Nurse-Led, Goal-Directed Lung Physiotherapy for Older Patients With Sepsis and Pneumonia in the ICU

Abstract

Objectives: This study aimed to investigate the effect of nurse-led, goal-directed lung physiotherapy (GDLPT) on the prognosis of older patients with sepsis caused by pneumonia in the intensive care unit.Methods: We conducted a prospective, two-phase (before-and-after) study over 3 years called the GDLPT study. All patients received standard lung therapy for sepsis caused by pneumonia and patients in phase 2 also received GDLPT. In this study, 253 older patients (age ≥ 65 years) with sepsis and pneumonia were retrospectively analyzed. The main outcome was 28 day mortality.Results: Among 742 patients with sepsis, 253 older patients with pneumonia were divided into the control group and the treatment group. Patients in the treatment group had a significantly shorter duration of mechanical ventilation [5 (4, 6) vs. 5 (4, 8) days; P = 0.045], and a lower risk of intensive care unit (ICU) mortality [14.5% (24/166) vs. 28.7% (25/87); P = 0.008] and 28 day mortality [15.1% (25/166) vs. 31% (27/87); P = 0.005] compared with those in the control group. GDLPT was an independent risk factor for 28 day mortality [odds ratio (OR), 0.379; 95% confidence interval (CI), 0.187–0.766; P = 0.007].Conclusions: Nurse-led GDLPT shortens the duration of mechanical ventilation, decreases ICU and 28-day mortality, and improves the prognosis of older patients with sepsis and pneumonia in the ICU.

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

“…On the basis of our previous studies, 17,18 we also improved our lung physiotherapy strategy. In this study, we not only promoted sputum drainage through early mobilization, vibration, and postural drainage but also ensured adequate humidification.…”

“…Detailed protocols for lung physiotherapy are given in our previous studies. 17,18 The improved nursing strategy, including an IPC strategy and lung physiotherapy strategy, was as follows (Figure 1).…”

“…9. Improved lung physiotherapy 17,18 (a) Head of bed elevated at 30°to 45°; (b) Sedation depth was assessed daily, maintaining RASS scale −2 to 1; delirium assessed every 6 h using the Confusion Assessment Method for ICU to guide early mobilization;…”

Early alteration of peripheral blood lymphocyte subsets as a risk factor for delirium in critically ill patients after cardiac surgery: A prospective observational study

“…We found that delirium was a frequent complication in older ICU patients, which was similar to previous studies ( Tafelmeier et al, 2019 ; Eertmans et al, 2020 ). Aging is an inevitable trend worldwide ( Sun et al, 2021 ), and could cause an increase in IL-6 and TNF-α in the CNS and peripheral bloodstream even in the absence of disease ( Krabbe et al, 2004 ). The aged brain is more fragile to neuroinflammation because of cellular senescence resulting from senescence-associated secretory phenotype and immunosenescence ( Guerrero et al, 2021 ).…”

Enhancing pulmonary function and arterial blood gas readings through immediate chest physiotherapy among extubated patients in ICU

“…Nurses play a critical role in managing pulmonary function and should be involved in the implementation and monitoring of chest physiotherapy as a respiratory therapy intervention. 21 This current study aimed to examine the effect of ICPT on pulmonary function and arterial blood gas readings among extubated patients in critical care units. The findings of this current study could potentially contribute to the existing literature and provide valuable insights into the effectiveness of chest physiotherapy as a respiratory therapy intervention.…”