The Effect Of Early Goal-directed Mobilisation In The Prevention Of Post-intensive Care Syndrome In Mechanically Ventilated Patients

Objective:Based on goal-directed theory,literature review and Delphi expert correspondence were used to construct an early rehabilitation program to prevent post-ICU syndrome in mechanically ventilated patients.Clinical application of the early goal-directed rehabilitation program constructed to analyze the preventive effect of this program on post-ICU syndrome in mechanically ventilated patients and provide reference for clinical nursing work.Methods:1.To establish an early goal-oriented rehabilitation team,the EGDM program was preliminarily formulated by reviewing domestic and foreign literature and guidelines,and the EGDM program was determined by using the Delphi expert letter method.2.Using the convenient sampling method,a total of 80 patients with comprehensive ICU mechanical ventilation in a tertiary hospital in Qingdao,Shandong Province from March 2021 to March 2022 were selected,and they were divided into 40 cases in the control group and 40 cases in the intervention group according to time.The control group took routine nursing measures,and the intervention group adopted an early goal-oriented rehabilitation program,formulated personalized activity goals according to the patient’s ICU activity scale,and implemented corresponding rehabilitation training according to the goals.The incidence of muscle strength,daily living ability,delirium,anxiety and depression,as well as the patient’s mechanical ventilation time and ICU length of stay To assess the effects of early goal-directed rehabilitation programmes for PIPS in mechanically ventilated patients.Results:1.In this study,the Delphi method was used to determine the EGDM scheme after two rounds of expert consultation:the effective recovery rate of the two rounds of questionnaires was 100%,and the authoritative coefficients were 0.833 and 0.833,respectively.The Kendall coordination coefficients of the two rounds of correspondence were 0.179(χ~2=72.404,P<0.01)and 0.184(χ~2=74.573,P<0.01),respectively,and the consensus of expert opinions was high.Finally,an early goal-oriented rehabilitation program consisting of 4 first-level indicators,12 second-level indicators and 22 third-level indicators was finalized.2.There was no significant difference in gender,age,diagnosis,and APACHEII score between the two groups(P>0.05),indicating that the baseline was consistent and comparable;the comparison of patients’muscle strength and self-care ability:when the patient was transferred out of the ICU and one week after the patient was transferred out of the ICU,the muscle strength score and the score of self-care ability in the intervention group were higher than those in the control group,and the difference was statistically significant(P<0.05);Comparison of depression scores:when transferring out of the ICU and one week after the patient was transferred out of the ICU,the anxiety and depression scores of the intervention group were lower than those in the control group,and the difference was statistically significant(P<0.05);the time of mechanical ventilation and ICU length of stay were compared:the time of mechanical ventilation and ICU stay in the intervention group were lower than that of the control group(P<0.05).Conclusions:1.Based on the goal-oriented concept,this study applied Delphi method to construct an early goal-oriented rehabilitation program after two rounds of expert consultation,and the constructed protocol was scientifically reliable and highly implementable,which could provide guidance for the implementation of early goal-oriented rehabilitation in ICU mechanically ventilated patients.2.Early goal-oriented rehabilitation programs can improve the muscle strength and voluntary mobility of ICU mechanically ventilated patients,improve patients’cognition,thereby reducing the occurrence of delirium,alleviating anxiety and depression,alleviating psychological trauma,and shortening the time of mechanical ventilation and hospital stay.This study protocol can reduce the occurrence of post-ICU syndrome in mechanically ventilated patients,which is conducive to better adaptation to life after discharge,which is feasible and effective.