Pulmonary Rehabilitation

Pulmonary rehabilitation is a comprehensive intervention program based on the comprehensive evaluation of patients, including but not limited to sports training, education, and behavior changes, aimed at improving the physical and psychological conditions of patients with chronic respiratory diseases. The first step is to assess the patient’s respiration.

Breathing Mode Analysis of Pulmonary Rehabilitation

Breathing mode is not only the external form of breathing, but also the real expression of internal function. Breathing is not only breathing, but also a movement mode. It should be learned and natural, neither depressive nor too slack.

Main Breathing Modes

Abdominal breathing: also known as diaphragmatic breathing. It works with the contraction of the abdominal muscles and the diaphragm, and the key is to coordinate their movements. When inhaling, relax the abdominal muscles, the diaphragm contracts, the position moves down, and the abdominal wall bulges. When exhalation, the abdominal muscles contract, the diaphragm relaxes, and returns to the original position, the abdomen is sunken, increasing the tidal volume of expiration. During breathing exercises, minimize the intercostal muscles and assist the breathing muscles to do their work to keep them relaxed and rested.

Chest breathing: most people, especially women, use chest breathing. This breathing method manifests as ribs move up and down and the chest expands slightly, but the central tendon of diaphragm does not contract, and many alveoli at the bottom of lung would not have expansion and contraction, so they cannot get good exercise.

Regardless of the central nervous regulatory factors, the most important factor affecting the respiratory pattern is the muscle. For intensive care patients, due to disease or trauma, long-term bedridden or poor activity, would have muscle strength decline, resulting in dyspnea.

Breathing is mainly related to the diaphragm. Without diaphragm, there is no breathing (of course, intercostal muscles, abdominal muscles, and trunk muscles work together to help people breath). Therefore, diaphragm training is the most important to improve the quality of breathing.

Respiratory Muscle Strength Test and Assessment in Pulmonary Rehabilitation

In order to avoid inspiratory muscle pressure caused by retraction force of the chest wall and lung, it is necessary to record the measurement value of functional residual volume. However, this lung volume is difficult to normalize. In clinical practice, the maximum inspiratory pressure and the maximum expiratory pressure are tested to determine the strength of the respiratory muscles. The maximum inspiratory pressure was measured by residual volume and the maximum expiratory pressure was measured by total lung volume. At least 5 measurements shall be made.

Objective of Pulmonary Function Measurement

① Understand the physiological state of respiratory system;

② To clarify the mechanism and types of pulmonary dysfunction;

③ Judge the degree of lesion damage and guide the rehabilitation of the disease;

④ To evaluate the efficacy of drugs and other treatment methods;

⑤ To evaluate the curative effect of the treatment of chest or extra-thoracic diseases;

⑥ To estimate the functional reserve of the lungs to provide reference for medical treatment, such as dynamic observation of the evolution of the course of the disease before surgery;

⑦ To evaluate labor intensity and endurance.

For medical personnel engaged in severe rehabilitation treatment, especially respiratory rehabilitation, it is necessary to know some methods, parameters, and physiological significance of lung function detection. The purpose is to correctly and timely identify the patient’s state and take appropriate treatment to save the patient’s life in an emergency.

Only after understanding the “quantity” of gas entering and the mechanism of the “quantity” of gas entering and exiting the tissues, and the meaning of various detection parameters, can we carry out targeted respiratory rehabilitation for critical patients under the premise of ensuring their safety.