Effects of structured protocolized physical therapy on the duration of mechanical ventilation in patients with prolonged weaning

Johannes Bickenbach; Sebastian Fritsch; Sophia Cosler; Yvonne Simon; Michael Dreher; Silke Theisen; Joyce Kao; Frank Hildebrand; Gernot Marx; Tim Philipp Simon

doi:10.1016/j.jcrc.2023.154491

Effects of structured protocolized physical therapy on the duration of mechanical ventilation in patients with prolonged weaning

J Crit Care. 2024 Apr:80:154491. doi: 10.1016/j.jcrc.2023.154491. Epub 2023 Dec 2.

Authors

Affiliations

¹ Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany. Electronic address: jbickenbach@ukaachen.de.
² Department of Intensive and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
³ Department of Physiotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.
⁴ Department of Pneumology and Internal Intensive Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany.
⁵ Project Management, Medical Faculty, RWTH Aachen University, Aachen, Germany.
⁶ Department of Orthopedics, Trauma and Reconstructive Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany; Department of Physiotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany.

PMID: 38042000
DOI: 10.1016/j.jcrc.2023.154491

Abstract

Purpose: 20% of patients with mechanical ventilation (MV) have a prolonged, complex weaning process, often experiencing a condition of ICU-acquired weakness (ICUAW), with a severe decrease in muscle function and restricted long-term prognosis. We aimed to analyze a protocolized, systematic approach of physiotherapy in prolonged weaning patients and hypothesized that the duration of weaning from MV would be shortened.

Methods: ICU patients with prolonged weaning were included before (group 1) and after (group 2) introduction of a quality control measure of a structured and protocolized physiotherapy program. Primary endpoint was the tested dynamometric handgrip strength and the Surgical Intensive Care Unit Optimal Mobilization Score (SOMS). Secondary endpoints were weaning success rate, ventilator-free days, hospital mortality, the prevalence of ICUAW, infections and delirium.

Results: 106 patients were included. Both the SOMS and the handgrip test were significantly improved after introducing the program. Despite no differences in weaning success rates at discharge, the total length of MV was significantly shorter in group 2, which also had lower prevalence of infection and higher probability of survival.

Conclusions: Protocolized, systematic physiotherapy resulted in an improvement of the clinical outcome in patients with prolonged weaning. Results were objectifiable with the SOMS and the handgrip test.

Keywords: ICU-acquired weakness; Mechanical ventilation; Physiotherapy; Prolonged weaning.

MeSH terms

Critical Illness / therapy
Hand Strength
Humans
Intensive Care Units
Physical Therapy Modalities
Respiration, Artificial* / adverse effects
Time Factors
Ventilator Weaning* / methods