Patients undergoing prolonged weaning from mechanical ventilation (MV) often suffer from distinct ICU-acquired weakness. Early mobilization on an ICU impacts outcome on patients, however, the impact and the evidence of structured and protocolized, objectifiable approaches in a patient group with prolonged is still scarce.

Systematic protocolized physiotherapy resulted in better muscle strength being objectified by the Surgical Intensive Care Unit Optimal Mobilization Score (SOMS) and the handgrip test. It also shortened the total length of ICU and weaning unit treatment as well as the total time on MV.

Structured and systematic physiotherapy might improve patient recovery and progress in prolonged weaning. Targeted multicenter studies could first create further evidence for this particular condition and objectifiable tests may detect patient-related outcomes.

20% of patients with mechanical ventilation (MV) have a prolonged, complex weaning process, often experiencing a condition of ICU-acquired weakness (ICUAW), with a severe decrease in muscle function and restricted long-term prognosis. We aimed to analyze a protocolized, systematic approach of physiotherapy in prolonged weaning patients and hypothesized that the duration of weaning from MV would be shortened.

ICU patients with prolonged weaning were included before (group 1) and after (group 2) introduction of a quality control measure of a structured and protocolized physiotherapy program. Primary endpoint was the tested dynamometric handgrip strength and the Surgical Intensive Care Unit Optimal Mobilization Score (SOMS). Secondary endpoints were weaning success rate, ventilator-free days, hospital mortality, the prevalence of ICUAW, infections and delirium.

106 patients were included. Both the SOMS and the handgrip test were significantly improved after introducing the program. Despite no differences in weaning success rates at discharge, the total length of MV was significantly shorter in group 2, which also had lower prevalence of infection and higher probability of survival.

Protocolized, systematic physiotherapy resulted in an improvement of the clinical outcome in patients with prolonged weaning. Results were objectifiable with the SOMS and the handgrip test.

Prolonged weaning

Mechanical ventilation

ICU-acquired weakness

Physiotherapy

© 2023 The Authors. Published by Elsevier Inc.