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

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

doi:10.1186/s12890-021-01461-2

Abstract

BackgroundProlonged 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.MethodsEighty 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).ResultsDiaphragmatic 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.ConclusionsEarly 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.

Highlights

Prolonged mechanical ventilation (MV) induces diaphragm dysfunction in patients in the intensive care units (ICUs)
39 patients were assigned to the early rehabilitation group and 41 patients were assigned to the control group
Baseline characteristics of patients Eighty patients who were admitted to the ICU during the study period and met the inclusion criteria were enrolled in the study

Summary

Introduction

Prolonged mechanical ventilation (MV) induces diaphragm dysfunction in patients in the intensive care units (ICUs). Mechanical ventilation (MV) is a life support technique that is routinely used in the intensive care units (ICUs) for patients with life-threatening conditions [1]. The diaphragm is the prima donna of the muscles involved in the respiratory system, and diaphragm function is crucial for successful weaning from MV [4]. Dong et al BMC Pulm Med (2021) 21:106 excessive or low pressure support, concurrent of critical illness polyneuropathy, patient-ventilator asynchrony and disseminated infection. This can lead to diaphragm myofiber atrophy and impaired diaphragm contraction, known as ventilator-induced diaphragmatic dysfunction (VIDD) [5]. US measurement of the diaphragm has been suggested to be valuable for predicting the optimal time for extubation in mechanically ventilated patients [12]

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Results

Conclusion