Multicomponent Pulmonary Rehabilitation for Prolonged Mechanical Ventilation in Patients Aged 80 Years or Older: A Randomized Controlled Trial.

Abstract

Older patients receiving prolonged mechanical ventilation have a low likelihood of successful ventilator liberation and remain at risk for infectious complications and death. In patients aged ≥80 years receiving prolonged mechanical ventilation, does a multicomponent pulmonary rehabilitation program increase successful weaning? This single-center, assessor-blinded randomized controlled trial was conducted at Chinese PLA General Hospital. Patients aged ≥80 years receiving prolonged mechanical ventilation were randomized to multicomponent pulmonary rehabilitation or standard rehabilitation. The primary outcome was successful weaning. Secondary outcomes were oxygen saturation off mechanical ventilation, 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. 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 HR = 5.11; 95% CI, 2.46-11.23; P < 0.001). There was no significant difference in the incidence of DVT between the two groups. The intervention group had 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, while 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 an sHR of 4.45 (95% CI, 2.11-9.36; P < 0.001). In patients aged ≥80 years receiving prolonged mechanical ventilation, the multicomponent pulmonary rehabilitation program improved physiological recovery and significantly increased successful weaning. Chinese Clinical Trial Registry; ChiCTR2100050342; registered on August 26, 2021; URL: https://www.chictr.org.cn/.