Mechanical Ventilation Complication Clinical Trial
Official title:
Comprehensive Rehabilitation Program Versus Traditional Chest Physiotherapy for Weaning From Mechanical Ventilator
Statement of the problem:
Are there any differences between comprehensive rehabilitation program consisted of
(peripheral muscle training and functional training) combined with inspiratory muscle
training and traditional chest physical therapy consisted of (percussion, mechanical
vibration, positioning and modified postural drainage) combined with inspiratory muscle
training on weaning from mechanical ventilation as a primary outcome, respiratory muscle
strength, peripheral muscle strength and functional status in difficult and prolonged weaning
from mechanical ventilation as secondary outcomes?
Purpose of the study:
The aim of the present study will be to compare between the effect of comprehensive
rehabilitation program combined with inspiratory muscle training and traditional chest
physical therapy combined with inspiratory muscle training on weaning from mechanical
ventilation as a primary outcome, inspiratory muscle strength, peripheral muscle strength,
functional status as secondary outcomes.
Significance of the study Survival of critically ill patients has increased as a result of
medical technology and interdisciplinary team cooperation.
Functional losses , reduced quality of life and survival , and increased healthcare costs are
consequences of prolonged immobility in ICU.
The European Respiratory Society and European Society of Intensive Care Medicine task force
has recommended a hierarchy of ICU mobilization based on progressively increasing exercise
intensity; decubitus change and functional positioning , passive mobilization , active-
assisted and active exertion , cycloegonometry in bed , sitting in bed orthostatism , static
walking , transferring from bed to chair, chair exertion and walking.
Failure to wean may have different etiologies such as underlying severe respiratory disease,
respiratory muscle dysfunction , metabolic and endocrine disorders and cognitive dysfunction.
Peripheral and respiratory muscles dysfunction is a consequence of prolonged mechanical
ventilation and ICU- acquired weakness. Weaning from mechanical ventilator should be
considered to be as early as possible to avoid complications caused by absence of spontaneous
breathing and further muscles atrophy.
Targeted mobility therapy (TMT) , simulating comprehensive rehabilitation program that will
be used in the present study, is a novel strategy for managing critically ill patients . This
concept will work as a scientifically- driven, dynamic bundle of rehabilitation intervention
that include inspiratory muscle strength training , bronchial hygiene , and active
mobilization . This concept will guarantee the bet outcomes for critically ill patients with
difficult and prolonged weaning as regards weaning success , days on mechanical ventilator ,
length of hospital stay and functional mobility.
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