Early rehabilitation relieves diaphragm dysfunction induced by prolonged mechanical ventilation: a randomised control study

Abstract

Background Prolonged mechanical ventilation (MV) induces diaphragm dysfunction in patients in the intensive care units (ICUs). Our study aimed to explore the therapeutic efficacy of early rehabilitation therapy in patients with prolonged MV in the ICU. Methods Eighty eligible patients who underwent MV for > 72 h in the ICU from June 2019 to March 2020 were enrolled in this prospective randomised controlled trial. The patients were randomly divided into a rehabilitation group (n = 39) and a control group (n = 41). Rehabilitation therapy included six levels of rehabilitation exercises. Diaphragm function was determined using ultrasound (US). Results Diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF) were significantly decreased in all patients in both groups after prolonged MV (p < 0.001). The rehabilitation group had significantly higher DTF (p = 0.008) and a smaller decrease in DTF (p = 0.026) than the control group after 3 days of rehabilitation training. The ventilator duration and intubation duration were significantly shorter in the rehabilitation group than in the control group (p = 0.045 and p = 0.037, respectively). There were no significant differences in the duration of ICU stay, proportion of patients undergoing tracheotomy, and proportion of recovered patients between the two groups. Conclusions Early rehabilitation is feasible and beneficial to ameliorate diaphragm dysfunction induced by prolonged MV and advance withdrawal from the ventilator and extubation in patients with MV. Diaphragm US is suggested for mechanically ventilated patients in the ICU. Trial registration Chinese Clinical Trial Registry, ID: ChiCTR1900024046, registered on 2019/06/23.

Efficacy of Physiotherapy Interventions on Weaning in Mechanically Ventilated Critically Ill Patients: A Systematic Review and Meta-Analysis

“…Therefore, the following RCTs were included in the present systematic review: Berti ( 33 ), Cader ( 34 ), Cader ( 42 ), Chen ( 35 ), Dong ( 36 ), Liu and Zhang ( 43 ), Martin ( 37 ), McCaughey ( 38 ), Pattanshetty and Gaude ( 39 ), Pinkaew et al ( 44 ), Sandoval Moreno ( 40 ), and Taniguchi ( 41 ).…”

“…The studies included were published between 2010 ( 39 ) and 2021 ( 36 ) and were conducted in America [United States n: 1 ( 37 ); Brazil n = 4 ( 33 , 34 , 41 , 42 ); Colombia n = 1 ( 40 )], Australia [ n = 1 ( 38 )], and Asia [China n = 2 ( 36 , 43 ), India n = 1 ( 39 ); Taiwan n = 1 ( 35 ); Thailand n = 1 ( 44 )].…”

“…Interestingly, respiratory muscle training has been the physiotherapy intervention most studied in the RCTs included in the present systematic review ( 34 , 37 , 38 , 40 , 42 , 43 ). On the other hand, three studies ( 36 , 39 , 40 ) assessed early mobilization/positioning, two studies ( 33 , 35 ) assessed airway clearance techniques (ACTs) and lung expansion, and one study ( 41 ) assessed automatic systems for MV weaning.…”

“…The intervention groups were compared to standard care/physiotherapy ( 33 – 36 , 39 – 44 ) or sham treatment ( 37 , 38 ).…”

Missed Nursing Care in Intensive Care Patients Subjected to Interhospital Capacity Transfers: A Retrospective Matched Case–Control Chart Review

“…Physiotherapy together with early active mobilisation have been some of the strategies to prevent the negative effects of critical illness, such as functional consequences, postintensive care syndrome and ICU-acquired weakness (40,41). Delayed mobilisation has previously been linked to longer ICU and hospital lengths of stay (42,43). Therefore, MNC in the form of less mobilisation that may occur during transfers could also be a contributing factor to longer ICU and hospital length of stay, as previously noted among transferred patients (4,5).…”