Application of Early Bundle Management of Mechanical Ventilation to Prevent Ventilator Dependence in Children

Study Overview
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Brief Summary
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This study is based on the risk factors of previous studies to formulate a bundle treatment plan to prevent ventilator dependence in children, in order to reduce the proportion of ventilator dependence in children and provide a theoretical basis for reasonable intervention of children with mechanical ventilation. Participants will receive intensive rehabilitation, nutrition, and tracheotomy at different time periods. Researchers will compare the control group to see whether it can reduce the incidence of ventilator dependence

Official Title
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Application of Early Bundle Management of Mechanical Ventilation to Prevent Ventilator Dependence in Children

Conditions
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Prolonged Mechanical Ventilation

Intervention / Treatment
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* Behavioral: early bedside rehabilitation
* Dietary Supplement: nutrition program
* Procedure: tracheotomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: （1）All stable children receiving mechanical ventilation （1）Stable condition: respiratory rate does not exceed 20% of the basic respiratory rate, PEEP< 8. 60%, VIS score< 20, there is no hypotension (70mmHg+ age ×2, 70mmHg under one year old), no higher than the P95 of the same sex and age Exclusion Criteria: Status epilepticus Active intracranial hemorrhage Intracranial hypertension Unstable fracture of the spine Spinal cord injury There are injuries that affect the implementation of rehabilitation Acute surgery was performed on the same day. Body temperature over 40℃ Brain function failure

Ages Eligible for Study
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Minimum Age: 28 Days
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Intervention group: The bundle treatment plan was:1) After receiving mechanical ventilation for <7 days, three of the following four items of intensive bedside rehabilitation were initiated: ① electrical diaphragm stimulation, ② electrical muscle stimulation, ③ passive limb movement, ④ respiratory rehabilitation. 2) Receive mechanical ventilation <14 days, start the target-oriented nutrition program, including: (1) nutrition department consultation, (2) MDT to develop individualized nutritional pathways, nutrient formulations and use methods, and achieve the target nutritional level within 2 weeks. 3) Receiving mechanical ventilation <21 days, tracheotomy transition to home mechanical ventilation (HMV), special diseases (central nervous system diseases) receiving mechanical ventilation 14-21 days recommended tracheotomy.
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: intervention group<br> | Behavioral: early bedside rehabilitation<br>* ① electrical diaphragm stimulation, ② electrical muscle stimulation, ③ passive limb movement, ④ respiratory rehabilitation.<br>Dietary Supplement: nutrition program<br>* (1) nutrition department consultation, (2) MDT to develop individualized nutritional pathways, nutrient formulations and use methods, and achieve the target nutritional level within 2 weeks<br>Procedure: tracheotomy<br>* early tracheotomy for special diseases (e.g central nervous system diseases) receiving mechanical ventilation 14-21 days recommended tracheotomy<br>|
| No Intervention: control group<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| limb skeletal muscle function indexes | Skeletal muscle thickness and cross-sectional area were measured | 21 days after enrollment |