基于竖脊肌横截面积减少率为离床指征的分阶段康复在ICU呼吸衰竭机械通气患者中的应用OA

Objective:To evaluate the impact of a staged rehabilitation protocol that incorporates an erector spinae muscle cross-sectional area(ESMcsa)reduction rate of≤10%as a key mobilization criterion on early mobility,clinical outcomes,and complications in mechanically ventilated patients with respiratory failure in the intensive care unit(ICU).Methods:Sixty mechanically ventilated patients with respiratory failure admitted to the ICU of Yijishan Hospital,Wannan Medical University,between Dec 2023 and Dec 2024 were enrolled and randomly assigned to either the observation group or the control group,with 30 cases in each group.The control group received IMS(ICU Mobility Scale)goal-directed staged rehabilitation,with mobilization indicated by an IMS score＞0 and tolerance of sitting on the edge of the bed for≥30 min.The observation group followed the same IMS goal-directed protocol,with the additional mandatory criterion of an ESMcsa reduction rate of≤10%for initiating out-of-bed activities.Rehabilitation duration,costs,mobility(IMS score)one week before and after intervention,successful weaning rate,and incidence of complications were compared between the two groups.Results:The observation group demonstrated significantly shorter duration of mechanical ventilation and overall hospital stay,a higher successful weaning rate,and lower treatment costs compared to the control group(P＜0.05).Before intervention,there was no significant difference in IMS scores between the two groups(P＞0.05).After intervention,the IMS score in the observation group was significantly higher than that in the control group(P＜0.05).The incidences of ICU-acquired weakness,pressure injuries,and orthostatic hypotension in the observation group were significantly lower than those in the control group(P＜0.05).Conclusions:Integrating an ESMcsa reduction rate of≤10%as a key mobilization criterion into IMS goal-directed staged rehabilitation optimizes the rehabilitation process.This approach significantly shortens the duration of mechanical ventilation and hospital stay,reduces medical costs and complication risks,improves successful weaning rate,and enhances patient mobility.