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.