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

BMC Pulm Med. 2021 Mar 29;21(1):106. doi: 10.1186/s12890-021-01461-2.


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.

Keywords: Diaphragm dysfunction; Diaphragm thickening fraction; Diaphragm ultrasound; Early rehabilitation; Mechanical ventilation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Diaphragm / diagnostic imaging
  • Diaphragm / pathology*
  • Diaphragm / physiopathology*
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Muscular Atrophy / prevention & control
  • Muscular Atrophy / rehabilitation*
  • Prospective Studies
  • Respiration, Artificial / adverse effects*
  • Time Factors
  • Ultrasonography
  • Ventilator Weaning