Chinese Journal of Emergency and Critical Care Nursing >
The construction and applicability analysis of a respiratory rehabilitation management program for the early postoperative period in patients undergoing cardiopulmonary bypass cardiac surgery
Received date: 2025-10-04
Online published: 2026-04-28
Supported by
National Key Research and Development Program of China(2022YFC2504505)
Objective To develop a respiratory rehabilitation program suitable for implementation in the early postoperative period in the ICU for patients undergoing cardiopulmonary bypass cardiac surgery. Methods A draft program was developed by synthesizing the best evidence through a systematic literature review. The Delphi method was then used to conduct two rounds of expert consultation with 15 specialists in critical care medicine and critical care nursing from 13 tertiary hospitals in 9 provinces across China，and the final program was established. Results The effective questionnaire recovery rates for the two rounds of Delphi consultation were 93.75% and 100%，respectively. The expert authority coefficients were 0.930 and 0.907，and the variation coefficients of each item were 0-0.13 and 0-0.22. After the second round，Kendall’s coefficient of concordance reached 0.323（P<0.001），indicating convergence of expert opinions. The final program comprises 12 themes and 37 items，covering the entire process of multidisciplinary collaboration，timing of initiation of respiratory rehabilitation，mechanical ventilation management，sedation and analgesia，lung recruitment strategies，respiratory muscle training，early mobilization，nutritional management，and safety monitoring. Conclusion This program is tailored to the ICU setting，specifies initiation of respiratory rehabilitation within 24 hours after surgery，and refines multidisciplinary roles and operational parameters，thereby translating guideline recommendations into executable clinical steps. It demonstrates strong scientific basis，practicality，and operability，and can provide systematic and standardized guidance for early postoperative respiratory rehabilitation in patients undergoing cardiopulmonary bypass cardiac surgery.
LI Zunzhu , CHANG Xiaowei , CAO Qianqian , ZHAO Mingxi , LUO Hongbo , JING Jie , SUN Jianhua , LAN Yuanmei , WU Xinjuan . The construction and applicability analysis of a respiratory rehabilitation management program for the early postoperative period in patients undergoing cardiopulmonary bypass cardiac surgery[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026 , 7(5) : 532 -539 . DOI: 10.3761/j.issn.2096-7446.2026.05.003
| [1] | Fischer MO, Brotons F, Briant AR, et al. Postoperative pulmonary complications after cardiac surgery:the VENICE international cohort study[J]. J Cardiothorac Vasc Anesth, 2022, 36(8 Pt A):2344-2351. |
| [2] | Zhang MQ, Liao YQ, Yu H, et al. Effect of ventilation strategy during cardiopulmonary bypass on postoperative pulmonary complications after cardiac surgery:a randomized clinical trial[J]. J Cardiothorac Surg, 2021, 16(1):319. |
| [3] | Serpa Neto A, Hemmes SN, Barbas CS, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery:a systematic review and meta-analysis[J]. Lancet Respir Med, 2014, 2(12):1007-1015. |
| [4] | Da L, Zhang K. Early pulmonary rehabilitation in ARDS patients:Effects on respiratory function and long-term outcomes:a retrospective study[J]. Medicine, 2024, 103(51):e41023. |
| [5] | Shan RF, Zhang L, Zhu YL, et al. Effect of early exercise rehabilitation on cardiopulmonary function and quality of life in patients after coronary artery bypass grafting[J]. Contrast Media Mol Imaging, 2022, 2022:4590037. |
| [6] | 许文慧, 王雅静. 心脏手术患者早期肺康复分级护理模式的应用研究[J]. 中国当代医药, 2021, 28(27):264-268. |
| Xu WH, Wang YJ. Application research on early pulmonary rehabilitation grading nursing scheme for patients undergoing cardiac surgery[J]. China Mod Med, 2021, 28(27):264-268. | |
| [7] | 国家心血管病中心《冠状动脉旁路移植术后心脏康复专家共识》编写委员会. 冠状动脉旁路移植术后心脏康复专家共识[J]. 中国循环杂志, 2020, 35(1):4-15. |
| National Center for Cardiovascular Diseases, Expert Consensus Writing Committee on Cardiac Rehabilitation After Coronary Artery Bypass Grafting. Expert consensus on cardiac rehabilitation after coronary artery bypass grafting[J]. Chin Circ J, 2020, 35(1):4-15. | |
| [8] | 朱政, 胡雁, 周英凤, 等. 推动证据向临床转化(五)证据临床转化研究中的文献质量评价[J]. 护士进修杂志, 2020, 35(11):996-1000. |
| Zhu Z, Hu Y, Zhou YF, et al. Promotion evidence to clinical transformation:evidence resource retrieval for the purpose of clinical transformation[J]. J Nurses Train, 2020, 35(11):996-1000. | |
| [9] | Smetana GW, Pfeifer K. Strategies to reduce postoperative pulmonary complications in adults[EB/OL]. (2025-05-28)[2025-09-26]. https://www.uptodate.cn/contents/strategies-to-reduce-postoperative-pulmonary-complications-in-adults. |
| [10] | Barbeito A, Dolinski MY, Lemm J. Postoperative care after cardiac surgery[EB/OL]. (2024-11-08)[2025-09-26]. https://www.uptodate.cn/contents/postoperative-care-after-cardiac-surgery. |
| [11] | British Association for Cardiovascular Prevention and Rehabilitation(BACPR). Standards and core components for cardiovascular disease prevention and rehabilitation,4th edition(2023)[EB/OL]. [2025-09-26]. https://static1.squarespace.com/static/66cc563eecc7a22020c7da6c/t/66ffa8f20aef5d0b272c6b0e/1728030962905/BACPR+Standards+and+Core+Components+2023.pdf. |
| [12] | Scottish Intercollegiate Guidelines Network. SIGN 150·Cardiac rehabilitation[EB/OL]. (2017-07-01)[2025-09-26]. https://guide.medlive.cn/guideline/13798. |
| [13] | 国家心血管病中心《中西医结合Ⅰ期心脏康复专家共识》专家委员会. 中西医结合Ⅰ期心脏康复共识[J]. 中华高血压杂志, 2017, 25(12):1140-1148. |
| National Center for Cardiovascular Disease,Expert Committee for the Expert Consensus on Phase I Cardiac Rehabilitation Integrating Traditional Chinese and Western Medicine. Consensus on integrated traditional Chinese and western medicine for phase I cardiac rehabilitation[J]. Chin J Hypertens, 2017, 25(12):1140-1148. | |
| [14] | Evangelodimou A, Patsaki I, Andrikopoulos A, et al. Benefits from implementing low-to high-intensity inspiratory muscle training in patients undergoing cardiac surgery:a systematic review[J]. J Cardiovasc Dev Dis, 2024, 11(12):380. |
| [15] | Aquino TN, Prado JP, Crisafulli E, et al. Efficacy of respiratory muscle training in the immediate postoperative period of cardiac surgery:a systematic review and meta-analysis[J]. Braz J Cardiovasc Surg, 2024, 39(1):e20220165. |
| [16] | Araújo CO, Araújo Alves CC, dos Santos FRA, et al. Inspiratory muscle training in phase 1 and 2 postoperative cardiac rehabilitation following coronary artery bypass graft surgery:systematic review with meta-analysis[J]. Phys Ther, 2024, 104(7):pzae061. |
| [17] | Fang LQ, Cheng AQ, Zhu ZH, et al. Effect of inspiratory muscle training on outcomes after cardiac surgery:a comprehensive meta-analysis of randomized controlled trials[J]. J Cardiopulm Rehabil Prev, 2024, 44(5):324-332. |
| [18] | Cordeiro ALL, Soares LO, Gomes-Neto M, et al. Inspiratory muscle training in patients in the postoperative phase of cardiac surgery:a systematic review and meta-analysis[J]. Ann Rehabil Med, 2023, 47(3):162-172. |
| [19] | Dsouza FV, Amaravadi SK, Samuel SR, et al. Effectiveness of inspiratory muscle training on respiratory muscle strength in patients undergoing cardiac surgeries:a systematic review with meta-analysis[J]. Ann Rehabil Med, 2021, 45(4):264-273. |
| [20] | Zhang SS, Li B, Meng XP, et al. The effects of inspiratory muscle training(IMT) on patients undergoing coronary artery bypass graft(CABG) surgery:a systematic review and meta-analysis[J]. Rev Cardiovasc Med, 2023, 24(1):16. |
| [21] | 王一木, 王灵雨, 刘靖宇, 等. 吸气肌训练对心脏外科手术患者干预效果的Meta分析[J]. 实用心脑肺血管病杂志, 2025, 33(5):101-109. |
| Wang YM, Wang LY, Liu JY, et al. Intervention effect of inspiratory muscle training for patients with cardiac surgical procedures:a meta-analysis[J]. Pract J Card Cereb Pneumal Vasc Dis, 2025, 33(5):101-109. | |
| [22] | Cordeiro ALL, Carvalho BSC, Silva EGD, et al. Inspiratory muscle training and functional capacity following coronary artery bypass grafting in high-risk patients:a pilot randomized and controlled trial[J]. J Clin Transl Res, 2022, 8(4):266-271. |
| [23] | Martinsson A, Houltz E, Wallinder A, et al. Lung recruitment in the prone position after cardiac surgery:a randomised controlled study[J]. Br J Anaesth, 2021, 126(5):1067-1074. |
| [24] | Zanini M, Nery RM, de Lima JB, et al. Effects of different rehabilitation protocols in inpatient cardiac rehabilitation after coronary artery bypass graft surgery:a randomized clinical trial[J]. J Cardiopulm Rehabil Prev, 2019, 39(6):E19-E25. |
| [25] | Manapunsopee S, Thanakiatpinyo T, Wongkornrat W, et al. Effectiveness of incentive spirometry on inspiratory muscle strength after coronary artery bypass graft surgery[J]. Heart Lung Circ, 2020, 29(8):1180-1186. |
| [26] | 彭雪茹, 沈旭慧. 瑜伽式呼吸训练对体外循环心脏术后病人康复的影响研究[J]. 全科护理, 2020, 18(29):3954-3957. |
| Peng XR, Shen XH. Study on effect of yogic breathing exercise on rehabilitation of patients after cardiopulmonary bypass[J]. Chin Gen Pract Nurs, 2020, 18(29):3954-3957. | |
| [27] | Nakamura K, Yamamoto R, Higashibeppu N, et al. The Japanese critical care nutrition guideline 2024[J]. J Intensive Care, 2025, 13(1):18. |
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