RT Journal Article
SR Electronic
T1 Physiotherapy and Weaning From Prolonged Mechanical Ventilation
JF Respiratory Care
FD American Association for Respiratory Care
SP 17
OP 25
DO 10.4187/respcare.06280
VO 64
IS 1
A1 Annia F Schreiber
A1 Piero Ceriana
A1 Nicolino Ambrosino
A1 Alberto Malovini
A1 Stefano Nava
YR 2019
UL http://rc.rcjournal.com/content/64/1/17.abstract
AB BACKGROUND: Patients undergoing prolonged mechanical ventilation represent up to 15% of all patients requiring weaning from mechanical ventilation. Although recent guidelines have recommended including physiotherapy early during mechanical ventilation to speed the process of weaning, only indirect evidence supporting the use of physiotherapy is available for patients receiving prolonged mechanical ventilation. The aim of our study was to evaluate the effects of a physiotherapy program in subjects requiring prolonged mechanical ventilation and the correlates of successful weaning.METHODS: A retrospective analysis was performed on 1,313 consecutive patients admitted to a weaning unit over a 15-y period to be liberated from prolonged mechanical ventilation. Subjects underwent a program of intensive physiotherapy organized in 4 incremental steps (1–4) and were analyzed according to the steps achieved (> 2 steps or ≤ 2 steps). The rate of successful weaning was recorded, and possible predictors were considered. The 15-y period of observation was divided into 3 consecutive 5-y intervals.RESULTS: Out of 560 subjects undergoing final analysis, 349 (62.3%) were successfully weaned. The weaning success rate was significantly greater in subjects attaining > 2 steps than in subjects who attained ≤ 2 steps (72.1% vs 55.9%, respectively, odds ratio = 2.04, 95% CI = 1.42–2.96, P < .001). Stepwise logistic regression analysis showed that achievement of > 2 physiotherapy steps was the main predictor of successful weaning (odds ratio = 2.17, 95% CI = 1.48–3.23, P < .001). Underlying disease was also a predictor of successful weaning. The overall rate of successful weaning decreased, and the median duration of weaning increased, during the period of observation.CONCLUSIONS: Our data support the inclusion of physiotherapy in the management of patients requiring prolonged mechanical ventilation.