Rehabilitation Program for Weaning From Mechanical Ventilator
Condition: Mechanical Ventilation Complication
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Comprehensive physical therapy rehabilitation program combined with inspiratory muscle training; Traditional chest physical therapy rehabilitation program combined with inspiratory muscle training
Intervention type(s): Other; Other
Intervention description(s): A threshold inspiratory muscle trainer will be connected to the artificial airway with 15 mm and 22 mm adaptors. Training bouts consist of three to five sets of six repetitions breathing through the trainer. Training will be conducted with the patient in bed with an approximately 30° head-up tilt and with intensity about 40 %- 50 % of maximal inspiratory pressure. Patients will be returned to mechanical ventilation for rest between training sets as needed. Three to five sets of six training breaths will be completed for a total of 18 to 30 training breaths per session. Following each training set, the patient indicated a rating of perceived inspiratory exertion on modified Borg scale . The study group will also receive comprehensive rehabilitation program consist of upper-extremity exercises, lower extremity exercises, pedaling exercises, trunk control exercises and bedside functional training; The same inspiratory muscle training for the study group combined with the traditional physical therapy program consist of positioning , modified postural drainage , percussion , vibration.
Other intervention name(s): Comprehensive physical therapy rehabilitation program; Traditional physical therapy rehabilitation program
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Fifty general surgery patients who are difficult and prolonged weaning patients from both sexes (men & women) with age ranged from 40 to 50 years old in surgical intensive care unit, Kasr Al Ainy Teaching Hospital, Cairo University and Beni- Suef Teaching Hospital , Beni -Suef University.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: rehabilitation; general surgery; difficult weaning