Early pulmonary rehabilitation physiotherapy tools and weaning outcomes In Critically ill Chronic Obstructed Airway Disease Patients; a randomized trial

Background: To compare the effectiveness of early pulmonary rehabilitation physiotherapy on mechanically ventilated COPD patient in RICU to those using current usual care regarding diaphragm function and weaning outcomes. Methods: a randomized controlled trial registered at Clinical trial.gov(NCT03253380), included 108 newly admitted COPD patients to RICU, who receive mechanical ventilatory(MV) support either noninvasive ventilation(NIV)or invasive mechanical ventilation(IMV).They divided into two groups: group Ι received the usual care plus pulmonary rehabilitation physiotherapy,and group II received the usual care alone.The outcomes (diaphragm function,MV duration,successful weaning,and lengths of hospital and ICU stay)were recorded. Results: Group 1 have statistically higher mean(mm)for all diaphragmatic function than group2,the early rehabilitation group had a shorter duration of MV and ICU stay, higher rate of simple successful weaning, less incidence of nosocomial pneumonia and significantly lower PCO2(mmHg)as compared to Group2. Patients with simple weaning have significantly higher mean electrical stimulation of quadriceps muscle and higher mean duration as compared to difficult weaning patients.Electrical stimulation(ms)and at weaning diaphragm function were observed to be significantly better predictors of simple weaning with higher AUC(p=0.016 and 0.000) respectively. Conclusions: Early rehabilitation physiotherapy for critically ill COPD patients, shortened the duration of MV, ICU and hospital stays, decreases thirty day mortality.