Functional recovery following physical training in tracheotomised and chronically ventilated patients. An observational prospective cohort study.

Background: Rehabilitation is a non-pharmacological therapy able to restore health status and reversing the patient’s disability. Since the efficacy of this treatment in critically ill patients is not enough documented, the present study aimed to assess whether the degree of change in individual’s functional status after comprehensive rehabilitation may influences the in-hospital clinical outcomes in a population of long-term ventilated patients.Methods: In a prospective cohort study we observed 77 tracheotomized patients (aged 75±7 yrs) admitted for difficult weaning in a regional weaning centre (RICU). Care plan including peripheral muscle training was delivered on a daily basis. Demographic, anthropometric and functional characteristics were measured at admission in all patients. Pre-to-post change in basic activity of daily living score (Δ-BADL), survival and weaning success rate were recorded as clinical outcomes. Pearson’s correlation analysis and a linear regression model with Δ-BADL as the dependent variable were performed to test the predictive power of any measurement taken at baseline.Results: Sixty-seven patients (87%) survived whereas 55 of them (74%) succeded weaning during stay in RICU. Δ-BADL was +2.53 point (SD 2.03, median 2). Performance of the broadest muscle of back (BMB) at baseline predicted Δ-BADL (β 0.388, 95% CI 0.111-1,664, p=0.026). Probability to remain ventilator-free (p=0.043) and to survive (p=0.001) differed across the categories of Δ-BADL (0=no change, 1-2=least improvement, and >2=improvement above median change). Conclusions: Mortality rate and weaning success vary according to the degree of change in basic activities following active training in tracheotomised, ventilated and difficult-to-wean patients. Broadest muscle of back performance was the only significant predictor of change in these activities.