Respiratory muscle stretching exercises improve oxygen saturation in post-extubation patients
Abstract
Background: Post-extubation patients frequently experience compromised respiratory function due to ventilator-induced diaphragmatic dysfunction (VIDD) and respiratory muscle fatigue resulting from prolonged mechanical ventilation and sedation effects. This condition manifests as decreased vital lung capacity and reduced oxygen saturation, significantly increasing the risk of extubation failure. The global extubation failure rate ranges from 10-20% in adult ICU populations, with reintubation carrying substantially higher mortality risk.
Objective: To determine the effect of respiratory muscle stretching exercises on oxygen saturation in post-extubation patients in the Intensive Care Unit of Bali Mandara General Hospital.
Methods: A quasi-experimental study with non-equivalent control group design was conducted from January to May 2025. The sample consisted of 38 post-extubation patients divided into treatment group (n=19) and control group (n=19) through purposive sampling technique. The treatment group received respiratory muscle stretching exercises targeting diaphragm, intercostal, and accessory respiratory muscles for 2 consecutive days with a frequency of 2 times daily (15-20 minutes per session), while the control group received standard care.
Results: The treatment group demonstrated significant improvement in oxygen saturation from baseline 92.11±1.853% to post-intervention 96.84±1.119% (mean change 4.73±1.593%, 95% CI: 3.96-5.50, p<0.001). In contrast, the control group showed only minimal non-significant change from 92.42±1.465% to 92.79±1.357% (mean change 0.37±1.342%, 95% CI: -0.29-1.03, p=0.175). The between-group difference in oxygen saturation improvement was statistically significant (4.36%, 95% CI: 3.378-5.342, p<0.001) with large effect size (Cohen’s d=2.18). All participants tolerated the intervention well with no adverse events reported, and subgroup analysis revealed greater benefit in patients with longer mechanical ventilation duration (>5 days).
Conclusions: Respiratory muscle stretching exercises are highly effective in improving oxygen saturation in post-extubation patients and can be implemented as a safe, cost-effective nursing protocol to prevent post-extubation complications and reduce extubation failure rates in ICU settings..
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