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

Zehua Dong, Ying Liu, Yubiao Gai, Pingping Meng, Hui Lin, Yuxiao Zhao, Jinyan Xing, Zehua Dong, Ying Liu, Yubiao Gai, Pingping Meng, Hui Lin, Yuxiao Zhao, Jinyan Xing

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.

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

Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Example of ultrasonographic view before and after rehabilitation. a Diaphragmatic excursion (DE) was viewed during breathing in B-mode (upper) and M-mode (lower) before rehabilitation. b DE was viewed during breathing in B-mode (upper) and M-mode (lower) after rehabilitation. c DTF was viewed at the area of apposition before rehabilitation. d DTF was viewed at the area of apposition after rehabilitation
Fig. 2
Fig. 2
Changes of DE (upper panel) and DTF (lower panel) in rehabilitation group (a) and control group (b)

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