Effect of Integrated Respiratory and Functional Training on Weaning from Mechanical Ventilation, Respiratory and Peripheral Muscle Strength, Functional Ability, and Pain After Emergency Abdominal Surgery: A Randomized Controlled Trial.

OBJECTIVE

To compare the effects of integrated respiratory and functional (multidimensional functional) training versus high-intensity inspiratory muscle training (IMT) plus conventional chest physiotherapy (CPT) on ventilator weaning after emergency abdominal surgery.

DESIGN

Prospective, multicenter, parallel-group, randomized controlled trial.

SETTING

Two intensive care units.

PARTICIPANTS

Ninety mechanically ventilated patients with difficult weaning following emergency abdominal surgery (N=90).

INTERVENTIONS: Participants were randomly assigned (1:1) to the study group and control groups. The study group received multidimensional functional training, high-intensity IMT and conventional chest physiotherapy. The control group received high-intensity IMT and conventional chest physiotherapy.

MAIN OUTCOME MEASURES: Primary outcomes were weaning success and maximal inspiratory pressure (MIP). Secondary outcomes included rapid shallow breathing index (RSBI), peripheral muscle strength, Functional Independence Measure (FIM), pain, weaning duration, and intensive care unit (ICU) length of stay.

RESULTS

Weaning success was significantly higher in the study group (95.6% vs 82.2%; P = .044). Both groups significantly improved MIP, with no between-group difference after treatment (mean difference [MD]=0.30 cmH₂O; 95% confidence interval [CI], -4.11 to 4.72; P=0.89). Compared with control group, the study group demonstrated significantly greater improvements in all peripheral muscle strength measures and FIM domains (all P<0.001), greater reductions in RSBI (MD=-3.92 breaths/min/L; 95% CI, -6.85 to -1.00; P=0.01) and pain (MD=3.22; 95% CI, 3 to 3.44; P<0.001), and shorter weaning duration (MD=-5.82 days; 95% CI, -7.98 to -3.67; P<0.001) and ICU length of stay (MD=-7.74 days; 95% CI, -11.37 to -4.11; P<0.001).

CONCLUSIONS

Both training approaches improved MIP, whereas multidimensional functional training resulted in higher weaning success and greater improvements in peripheral muscle strength, functional independence, pain, weaning duration, and ICU length of stay than high-intensity IMT+CPT in patients following emergency abdominal surgery.