- Design
- Single-centre, assessor-blinded randomised controlled trial
- Population
- 150 patients aged 80 or over on prolonged mechanical ventilation, China
- Primary outcome
- Successful weaning
- Effect
- 45.3% vs 12.0%; adjusted HR 5.11 (95% CI 2.46-11.23)
This single-centre, assessor-blinded randomised trial at a Chinese hospital enrolled 150 patients aged 80 or over receiving prolonged mechanical ventilation. They received a multicomponent pulmonary rehabilitation programme or standard rehabilitation.
Successful weaning was achieved by 45.3% with the programme and 12.0% with standard care (adjusted HR 5.11, 95% CI 2.46 to 11.23). The programme group more often met targets for oxygen saturation off the ventilator, diaphragm thickening, cough strength and muscle strength, and had less ventilator-associated pneumonia at 60 and 90 days. Deep vein thrombosis and 90-day mortality (2.7% vs 4.0%) did not differ.
The result is large for a single centre, and the abstract does not detail the programme's components. But it challenges the view that very old patients on prolonged ventilation cannot be weaned, and supports structured, active rehabilitation rather than passive care.
- Offer structured, active rehabilitation to older patients on prolonged ventilation rather than passive care alone.
- Work with physiotherapy to combine airway clearance, cough work and strengthening, since the trial's programme was multicomponent.
- Measure diaphragm function and cough strength to track progress.
- Do not assume age alone rules out weaning.
Why it matters
It challenges the expectation that the very old on prolonged ventilation will not come off it.
Don't overread it
Single-centre trials often show larger effects than later multicentre ones.
The statistics, in plain English
A hazard ratio of 5.11 means patients in the programme were weaned at about five times the rate. The wide confidence interval (2.46 to 11.23) reflects 150 patients at one centre; results at other centres may be smaller.
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