Application Of Vibrational Positive Pressure Expiratory Technique After Extubation In Elderly Patients With AECOPD

Objective:To evaluate the effect of active cycle breathing combined with oscillating positive expiratory pressure on respiratory function training in elderly patients with acute exacerbation of chronic obstructive pulmonary disease after extubation.Method:According to the inclusion and exclusion criteria,72 elderly patients with AECOPD after extubation in the Department of Critical Care Medicine of a general hospital in Mianyang from March 2022 to December 2022 were selected as the research objects.They were divided into 2 groups based on randomized numbers.The control group used active cycle breathing technique for breathing training after extubation.These included respiratory control,chest expansion exercises,and forced exhalation.The intervention was administered 3 times daily for about 15 to 20 minutes each time for 2 weeks.Based on the active cycle breathing technique,the experimental group was treated with a positive fluctuating expiratory pressure after extubation.The reset rate of tracheal intubation,cough and sputum,dyspnoea score,lung function,and arterial blood gas indices were compared between the two groups after extubation.The length of stay in intensive care after extubation and the rate of readmission to intensive care within 48hours were documented.Results:1.A total of 72 patients were registered,35 in the control group and 37 in the experimental group.There were no significant differences in age,gender,BMI,weight,height,education level,number of comorbidities,marital status,smoking history,duration of COPD,APACHE II,and duration of mechanical ventilation between the two groups（P>0.05）.Before the procedure,there were no statistically significant differences in cough and sputum,dyspnea score,lung function,and arterial blood gases between the two groups（P>0.05）.2.There was no significant difference in the 48-hour tracheal re-initialization rate between the two groups（P>0.05）.There was no statistically significant difference between FEV₁,FEV₁%pred and FEV₁/FVC between the two groups 2 weeks after intervention（P>0.05）.There was no significant difference in PH from 1 week to 2weeks post-operatively（P>0.05）.None of the patients from either group were readmitted to the ICU within 48 hours.3.The scores of expectoration and dyspnea in the experimental group were statistically different from those in the control group 1 week and 2 weeks after intervention（P<0.05）.After 1 week and 2 weeks of intervention,the Pa O₂of the experimental group was higher than that of the control group,and the Pa CO₂was lower than that of the control group.The difference between the two groups was statistically significant（P<0.05）.The length of ICU stay after extubation in the experimental group was shorter than that in the control group,and the difference was statistically significant（P<0.05）.Conclusions:The 48-hour tracheal intubation reset rate,pulmonary function,arterial blood PH value,and 48-hour ICU readmission rate of oscillating positive expiratory pressure technique are similar to those of active circulation breathing technique.However,it has some advantages in improving cough,sputum,dyspnea,Pa O₂increase,Pa CO₂reduction,and shortening the duration of ICU stay after extubation.The technique of positive oscillating expiratory pressure can effectively promote the evacuation of respiratory secretions,improve clinical symptoms and shorten the duration of stay in ICU.It can be used as a measurement of early respiratory function formation for older patients with AECOPD after extubation.