Pulmonary rehabilitation within intensive care units exemplified by traffic collisions casualties

Abstract

The early introduction of a rehabilitation procedure is of vital importance in the process of acting upon the respiratory system. In comprehensive therapy, pulmonary rehabilitation is perceived as an integral part of treatment for mechanically ventilated patients. The aim of this work was to conduct a comparative analysis of pulmonary rehabilitation concerning patients who had sustained an injury as the result of traffic collisions, and were subsequently treated in an intensive care unit (ICU). Research material consisted of information contained in the medical documentation of 43 patients, ranging in ages from 15 to 57 years, treated in the ICU for injuries sustained during traffic collisions. This analysis involved the values of the parameters recorded first on admission of the patient to the unit, and then every 7 days thereafter, and finally upon discharge from the ICU, and included: arterial blood gasometry, pulsoxymetry, capnometry, body temperature, arterial blood pressure, and pulse rate. Pneumonia occurred most frequently in patients ventilated mechanically during the period from the 15 th to the 28 th day of hospitalization and constituted 60% of the total occurring pneumonias. Deaths were observed more often in patients with acidosis and hypercapnia. Values of arterial oxygen saturation of hemoglobin (SaO 2 ) below 94% were recorded in that group of patients for whom therapeutic procedures ended in failure (40%). For the remaining patients, SaO 2 values exceeded 94%. The analysis of our material showed divergences concerning the values of partial pressure of end-tidal carbon dioxide (PetCO 2 ) and partial pressure of carbon dioxide in the arterial blood (PaCO 2 ). The mean values of SaO 2 and percutaneous monitoring of hemoglobin oxygen saturation (SpO 2 ) were similar. The length of stay within the ICU is significant with respect to the occurrence of complications in the form of pneumonia. Patients whose parameter values were within the norm during pulmonary rehabilitation attained spontaneous respiration at discharge. SpO 2 and PetCO 2 are of vital importance in the pulmonary rehabilitation process, complemented by regularly taken arterial blood gasometry measurements.