Multicomponent Pulmonary Rehabilitation for Prolonged Mechanical Ventilation in Patients 80 Years of Age or Older: A Randomized Controlled Trial
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Tingting Liu1, Ting Kou2, Ge Wei3
1Department of Respiratory and Critical Care, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
Background:
Older patients receiving prolonged mechanical ventilation (MV) have a low likelihood of successful ventilator liberation and remain at risk of infectious complications and death.
Research Question:
In patients ≥ 80 years of age receiving prolonged MV, does a multicomponent pulmonary rehabilitation program increase successful weaning?
Study Design And Methods:
This single-center, assessor-masked randomized controlled trial was conducted at Chinese PLA General Hospital. Patients ≥ 80 years of age receiving prolonged MV were randomized to multicomponent pulmonary rehabilitation or standard rehabilitation. The primary outcome was successful weaning. Secondary outcomes were oxygen saturation while not receiving MV, diaphragm thickening fraction, cough ability, muscle strength, and the incidence of ventilator-associated pneumonia (VAP) assessed at 30, 60, and 90 days. Deep vein thrombosis (DVT) was assessed at day 90 or when participation ended.
Results:
The intention-to-treat analysis included 75 patients in each group. Among patients who received the multicomponent pulmonary rehabilitation program, 45.3% achieved successful weaning, compared with 12.0% among patients receiving standard rehabilitation (adjusted hazard ratio [HR], 5.11; 95% CI, 2.46-11.23; P < .001). No significant difference was found in the incidence of DVT between the 2 groups. The intervention group showed higher odds of meeting the prespecified improvement criteria for oxygen saturation, diaphragm thickening fraction, cough strength, and muscle strength at 30, 60, and 90 days, whereas VAP incidence was lower at days 60 and 90. The all-cause mortality rate at 90 days was 2.7% (2/75) in the trial group and 4.0% (3/75) in the control group (P = 1.000). The per-protocol analysis yielded similar results. The Fine-Gray competing risk analysis yielded a subdistribution HR of 4.45 (95% CI, 2.11-9.36; P < .001).
Interpretation:
Our results show that in patients ≥ 80 years of age receiving prolonged MV, the multicomponent pulmonary rehabilitation program improved physiologic recovery and significantly increased successful weaning.
Clinical Trial Registration:
Chinese Clinical Trial Registry; No.: ChiCTR2100050342; URL: www.chictr.org.cn.
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