Association of Mobilization and Chest Physiotherapy on Weaning Outcome of Prolonged Weaning Subjects: A Retrospective Cohort.

BACKGROUND AND PURPOSE: Prolonged weaning-characterized by failure in three consecutive spontaneous breathing trials (SBTs) and requiring over 7 days of mechanical ventilation post-initial SBT-presents a critical clinical challenge often exacerbated by intensive care unit-acquired weakness (ICU-AW) and impaired airway clearance. Mobilization and chest physiotherapy (CPT) are promising therapeutic strategies. This study evaluated the association between a combined mobilization and CPT protocol and weaning outcomes in subjects requiring prolonged mechanical ventilation using a retrospective historical control design.

METHODS

This retrospective cohort study analyzed 202 subjects who need a requirement for prolonged mechanical ventilation exceeding 21 days admitted to Respiratory Care Center (RCC). Outcomes were compared between a historical control cohort (2018/01/01-2020/01/01; n = 100), which received standard medical care without mobilization or CPT, and an intervention cohort (2020/01/01-2022/03/01; n = 102), which received the combined protocol. The primary outcome was occurrence of weaning failure; the secondary outcome was RCC mortality occurrence. Multivariable logistic regression was performed to determine independent predictors of weaning failure occurrence.

RESULTS

Multivariable logistic regression demonstrated that receiving mobilization and CPT was independently associated with lower weaning failure occurrence (OR 0.22, 95% CI [0.10, 0.49], p < 0.001), and Acute Physiology and Chronic Health Evaluation II (OR 1.08, 95% CI [1.01, 1.15], p = 0.018) were also associated with higher weaning occurrence, whereas age (OR 1.02, 95% CI [0.99, 1.02], p = 0.174) and GCS (OR 1.03, 95% CI [0.95, 1.11], p = 0.442) were not. No significant difference was detected in RCC mortality occurrence with non-adjusted comparison (OR 1.58, 95% CI [0.54-4.63], p = 0.398).

DISCUSSION: Receiving mobilization and CPT was independently associated with lower odds of weaning failure occurrence in RCC, likely due to improved pulmonary hygiene and reduced ICU-acquired weakness. RCC mortality occurrence did not differ between groups, supporting safety.