Effects of incentive spirometry respiratory trainer device on lung recruitment in non-intubated mechanical ventilation moderate ARDS patients: A retrospective study

OBJECTIVES: A retrospective study was performed to investigate the effects of incentive spirometry (IS)respiratory trainer device on lung recruitment in non-intubated moderate ARDS patients. METHOD: Moderate ARDS patients who non-intubated from January 2019 to October 2022 were enrolled to the lung recruitment group and the control group. Compared the PaO(2)/FiO(2) (P/F)ratio, lung ultrasound (LUS) score, APACHE-II score, Maximum inspiratory volume during three days (baseline, Day1, Day2, Day3) and the rate of intubation, mean hospital stay, the 28-day in-hospital mortality and the 90-days in-hospital mortality between the two groups. RESULTS: The lung recruitment group 118 patients (73 males, 47.6 ± 16.5y) and the control group 103 patients (62 males, 50.2 ± 14.8y) were included. The P/F ratios, APACHE-II scores, LUS scores, and the maximum inspiratory volume (ml) were significantly different between the two groups (P = 0.000, P = 0.014, P = 0.013 and P = 0.001, respectively).The P/F ratios were higher (252.6 ± 55.6 v.s, 166.96.9re, p = 0.035, day2), (269.8 ± 75.7 v.s 183.9 ± 68.6, p = 0.027, day3), the APACHE-II scores were lower (10.0 ± 2.4 v.s 15.3 1e l p = 0.025, day2), (8.0 ± 1.4 v.s 14.1 ± 2.7, p = 0.000, day3), the LUS scores were higher (16.2res wv.s 21.61.6w, p = 0.043, day2), (11.4 ± 5.9 v.s 20.3 ± 6.9, p = 0.004, day3), the maximum inspiratory volumes were higher (1722.3 ± 432.2 v.s 1310.70.732., p = 0.044, day2), (1913.5467.2 v.s 1299.79452.5, p = 0.018, day3) in Lung Recruitment group than that in Control group. These data at day1, day2, and day3 were significantly improvement than baseline in Lung Recruitment group. Only 36 patients (30.5%) in Lung Recruitment group needed to intubation, while 48 patients (46.6%) in Control group (p = 0.014). The mean hospital stay in lung recruitment group was lower (12.6 ± 4.6 v.s, 18.4 ± 5.3, P = 0.018). The 28-days and the 90-days in-hospital mortality were no statistical significance between the two groups (P = 0.414 and P = 0.418, respectively). CONCLUSIONS: Using IS to perform lung recruitment in moderate ARDS patients can improve maximum inspiratory volume, PaO(2)/FiO(2) ratio, LUS scores, and APACHE-II score and reduce the rate of intubation and the mean hospital stay, but the 28 days and the 90-days in-hospital mortality were not improved.