Functional and structural respiratory impairment in cerebral palsy- GMFCS IV and V: Insights from ultrasound and inspiratory muscle testing.

Respiratory muscle ultrasound as a key predictor of successful weaning from mechanical ventilation in critically ill obstetric patients: a prospective observational study.

Diaphragmatic ultrasound in guiding weaning from invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease.

A few studies investigating the perioperative use of lung ultrasound (LUS) have shown loss of lung aeration with decline in diaphragmatic function after general anesthesia. We aimed to measure changes in lung aeration and diaphragmatic functions using LUS in patients undergoing elective laparoscopic cholecystectomy. Forty patients of American Society of Anesthesiologists I/II undergoing elective laparoscopic cholecystectomy under general anesthesia were enrolled. For all patients, LUS examination was performed at 5 time points: preoperative room, after intubation, after deflation of pneumoperitoneum, 30 min after extubation, and 24 h post-extubation. The aeration loss was assessed using the modified LUS score. The diaphragmatic excursion was also evaluated preoperatively, and at 30 min and 24 h post-extubation. A progressive increase in modified LUS score was seen after intubation, after deflation of pneumoperitoneum, 30 min postoperative, after extubation and 24 h post-extubation at postoperative anesthesia care unit (PACU) as compared to preoperative room (P < 0.0001). The maximum modified LUS score was observed postoperatively after 30 min: 8 (5, 10) and 24 h post-extubation in PACU: 8 (4.25, 11.0). No significant change in the diaphragmatic excursion or respiratory complications was observed. Our study found a progressive loss of lung aeration after the induction of general anesthesia in laparoscopic cholecystectomy, extending up to the 24-h perioperative period. However, diaphragmatic excursion remained unchanged. The study also suggests that LUS is a valuable tool for detecting perioperative atelectasis and quantifying the aeration loss.

Patients with Fontan circulation have reduced functional capacity, due to a reduced cardiac output, but also to an abnormal lung function and respiratory muscle weakness. This study aimed to assess lung function and exercise capacity in a cohort of patients with Fontan circulation and evaluate the prognostic impact of restrictive lung function (RLF). In addition, diaphragmatic ultrasound (DUS) investigated diaphragmatic function in a subgroup of patients. Patients with Fontan palliation who underwent lung function evaluation were included. A subgroup of patients additionally underwent DUS to assess diaphragmatic function. The study population consisted of 53 post-Fontan patients (mean age 25 ± 10 years). Exercise capacity was reduced, with a median peak VO₂ of 18.4 mL/kg/min (IQR 14.7-22.6). Oxygen pulse was reduced and flattened, and ventilatory efficiency was impaired (mean VE/VCO₂ slope 36 ± 7), without evidence of mechanical ventilatory limitation. Spirometry revealed RLF in 48% of patients. RLF was associated with lower peripheral oxygen saturation, diuretic therapy use, and lower engagement in regular physical activity. Moreover, RLF was significantly associated with adverse events at follow-up (χ²: 6.8, p = 0.004). Diaphragm ultrasound (DUS), performed in 10 patients, showed abnormal function of at least one hemidiaphragm in most cases. Patients with Fontan circulation exhibit a markedly reduced exercise functional capacity resulting from a complex interplay between cardiac, pulmonary, and peripheral factors. Restrictive lung function was associated with increased need for diuretic therapy and lower levels of physical activity. Abnormal diaphragmatic function was frequently observed and may represent a potentially modifiable contributor to functional limitation warranting further investigation.

Abstract Background The main causes of death in amyotrophic lateral sclerosis (ALS) are respiratory and bulbar dysfunctions. Phrenic nerve conduction studies and diaphragm ultrasound can be used to assess the diaphragmatic function which is the primary muscle of respiration. Furthermore, the bulbar function can be assessed by the tongue ultrasound. The study included eleven patients with definite ALS; 8 males and 3 females with mean age of 44.55 ± 8.90 years. All patients were subjected to phrenic nerve conduction studies, ultrasound of the diaphragm and ultrasound examination of the tongue. Results In 54.4% of the patients, the phrenic nerve compound motor action potential (CMAP) amplitude was reduced. All patients had a normal respiratory thickening ratio, although 9.09% of the patients had abnormal diaphragmatic excursion. This revealed a statistically significant difference (p value = 0.022) between diaphragm ultrasound and phrenic nerve amplitude. The revised ALS functional rating scale (ALSFRS-R) respiratory sub-score and the phrenic nerve amplitude had a significant correlation ( p = 0.007), although diaphragm ultrasound did not. The sensitivity for tongue echo intensity was 63.6%. Conclusion Our study showed that the diaphragm ultrasound was inferior to phrenic nerve amplitude in assessment of respiratory functions. Tongue echo intensity could be an adjuvant tool in assessment of bulbar functions in addition to other more sensitive methods.

In critically ill mechanically ventilated patients, positive end-expiratory pressure (PEEP) is applied to limit alveolar collapse. However, PEEP will also affect diaphragm geometry and function. Various animal models are used to study the effects of mechanical ventilation on the diaphragm, but chest wall mechanics may influence diaphragm responses to PEEP. We hypothesized that interspecies differences are relevant when studying the effect of PEEP on diaphragm geometry during mechanical ventilation. Specifically, the chest wall compliance, which varies among species, may be an important determinant of the effect of PEEP on diaphragm geometry and function. This is relevant in future studies into diaphragm adaptations during PEEP and particularly in genetically engineered animal models. Using magnetic resonance imaging (MRI), we studied the effect of PEEP on diaphragm surface and thorax geometry in ventilated mice, rats and healthy volunteers. PEEP reduced diaphragm surface in mice, rats and humans, but the effect was smaller in mice compared to rats. This difference was not attributable to disparities in lung compliance or chest wall compliance. Compared to healthy volunteers, rats showed a larger decrease in diaphragm surface due to greater caudal displacement, while mice showed a similar decrease in diaphragm surface, but with more thoracic widening. These findings indicate that the effect of PEEP on diaphragm geometry is influenced by chest wall movement and varies across species. These findings are critical for interpreting diaphragm adaptations to mechanical ventilation in both animal models and patients.

Interscalene block versus upper trunk block in shoulder arthroscopy: Randomized comparative study of the ease between the two techniques among residents.

To describe and assess diaphragmatic function by ultrasound during the weaning and post-extubation phases in preterm newborns. This cross-sectional study included intubated preterm newborns eligible for extubation. Inspiratory diaphragmatic thickness (IDT), expiratory diaphragmatic thickness (EDT), diaphragmatic thickening fraction (DTF), and diaphragmatic excursion (DE) were evaluated at three time points: T1-during invasive mechanical ventilation (IMV); T2-during the spontaneous breathing trial (SBT); and T3-during nasal intermittent positive pressure ventilation (NIPPV). Friedman test and Wilcoxon signed-rank post hoc test were used for comparisons (p < 0.05). Fifty preterm newborns were evaluated. Forty-five (mean gestational age 30.9 ± 2.2weeks; mean weight 1377.5 ± 432g) received IMV for 4 ± 3days and were successfully extubated (extubation failure rate 10%). Due to the small number of failures (n = 5), only descriptive analyses were performed. In successfully extubated newborns, IDT and DE increased at T2 and T3 compared to T1 (p < 0.05), with IDT highest at T2. No significant changes were observed in EDT or DTF, which remained consistently elevated.Conclusion: In preterm newborns successfully extubated, diaphragmatic thickness and excursion increased during the SBT and remained elevated after extubation. These findings may support the use of diaphragmatic ultrasound to guide extubation readiness and monitor post-extubation adaptation in preterm infants.

Background:This study explored the performance of bedside ultrasound monitoring of diaphragmatic function in predicting the ventilator weaning outcomes of patients with cervical spinal cord injury. Material/Methods:The clinical data of 136 eligible patients hospitalized from December 2021 to December 2023 were obtained for this prospective study, and they were assigned into weaning failure and weaning success groups.Intergroup comparisons were conducted on the general data and diaphragmatic function parameters: diaphragm excursion (DE), diaphragm thickening fraction (DTF), diaphragm contraction velocity (DCV), diaphragmatic-shallow rapid breathing index (D-RSBI), diaphragmatic thickness at the end of expiration (DTee), and diaphragmatic thickness at the end of inspiration (DTei). Results:Among the diaphragmatic function parameters, decreases in DE and DTF but increases in DCV and D-RSBI were observed in the weaning failure group compared with those in the weaning success group (P<0.05).There were no significant differences in DTei and DTee between the 2 groups (P>0.05).The areas under the receiver operating characteristics (ROC) curves of DE, DTF, DCV, and D-RSBI alone and their combination for predicting ventilator weaning outcomes were all >0.70, and the combination had the highest predictive value.The combination of DE, DTF, DCV, and D-RSBI was superior to the 4 parameters alone in terms of the net benefit for predicting ventilator weaning outcomes in the threshold ranges of 0-0.842, 0.843-0.878,and 0.907-1.000. Conclusions:Bedside ultrasound monitoring of diaphragmatic function parameters DE, DTF, DCV, and D-RSBI has good predictive value for the ventilator weaning outcomes of patients with cervical spinal cord injury.

Diaphragmatic function is stable in healthy neonates without significant pulmonary involvement on LUS during the first three postnatal days. Mode of delivery appears to transiently influence diaphragmatic performance on DOL 1. Combined DUS and LUS provide complementary insights into neonatal respiratory adaptation and may serve as reference values for clinical practice and research. • Point-of-care diaphragmatic ultrasound (DUS) and lung ultrasound (LUS) are increasingly utilized as safe, bedside tools for assessing neonatal respiratory distress and supporting clinical decision-making. • This is the first study to evaluate both DUS and LUS together in healthy term newborns during the first 3days of life,demonstrating stable diaphragmatic function transiently influenced by delivery mode but independent of newborn sex.

Neuromuscular ultrasound (NMUS) is becoming increasingly incorporated as a complementary tool in electrodiagnostic (EDX) medicine. Competency assessment is critical to ensure adequate quality, appropriate application, and accurate interpretation. The primary objective was to develop a competency-based assessment tool of foundational NMUS skills among postgraduate medical trainees in a single center. The assessment included written (28 multiple-choice, short answer, or yes/no) questions and practical skills (15 prompts) sections recommended by a published consensus-based survey to include the knowledge and skills necessary to achieve minimal competency for unsupervised practice of NMUS for common conditions. The written portion included interpretation of basic pathology. Core practical content focused on the most evaluated structures in the Mayo EDX laboratory: the median and ulnar nerves and diaphragm muscle. The practical portion was administered by a single examiner and scored with a five-point competency-based rating. Four experienced educators used the Angoff standard setting method to set passing scores for each section. Subjects included three EMG-track clinical neurophysiology fellows who completed a NMUS lecture series with supervised hands-on scanning and a 2-week intra-lab NMUS elective during fellowship. Composite scores ranged from 89% to 97%. All subjects met minimum passing scores for each section (77% and 88% for the knowledge and skills sections, respectively). This NMUS competency assessment was successfully implemented and may be incorporated into postgraduate medical trainee evaluation to ensure minimal competency in evaluation of carpal tunnel syndrome, ulnar neuropathy at the elbow, and diaphragm function. This effort integrates quality NMUS evaluations into clinical practice.

Spinocerebellar ataxia type 3 (SCA3) is one of the most prevalent hereditary neurodegenerative disorders, with respiratory failure being the leading cause of mortality. Nevertheless, pulmonary function in SCA3 has not been thoroughly characterized, and the underlying mechanisms remain unclear. We conducted pulmonary function tests in both patients and healthy controls, as well as in SCA3 mice and wild-type mice. In participants, we used diaphragm ultrasonography to evaluate diaphragmatic dysfunction. We examined clinical features and inflammatory biomarkers to identify independent associations with pulmonary function. We also performed histopathological and immunohistochemical analyses on lung tissues from SCA3 mice to assess the presence of chronic airway inflammation. We enrolled 102 patients and 91 healthy controls for pulmonary function testing. For blood biomarker analyses, SCA3 participants with available blood data were drawn from the same patient cohort and were compared with an independent cohort of 88 age- and sex-matched healthy controls, distinct from the pulmonary-function controls. Compared with controls, patients showed significant reductions in FVC (P < 0.001), FEV1 (P < 0.001), DLco-SB (P = 0.015), and small-airway flow indices (P < 0.05), along with an increased RV/TLC ratio (P < 0.001), indicating subclinical pulmonary dysfunction. Impaired pulmonary function, defined according to prespecified criteria, was identified in 71/102 (69.6%) patients versus 0/91 controls (P < 0.001). Pulmonary impairment was associated with ataxia severity (SARA: OR = 1.196, 95% CI 1.038–1.376; P = 0.013). Diaphragm ultrasound showed preserved diaphragmatic function, whereas systemic inflammatory markers were associated with reduced pulmonary function, with NLR inversely correlated with MEF25 (ρ =–0.272, P = 0.010). In SCA3 mice (n = 4) compared with wild-type mice (n = 3), pulmonary function abnormalities and lung pathology were consistent with airway inflammatory changes. SCA3 is associated with early, subclinical pulmonary dysfunction that worsens with disease progression. Chronic inflammation in the small airways may be involved in this process. Our findings underscore the need for early intervention with chest physiotherapy and respiratory training as part of the clinical management of SCA3.

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory disorder characterized by irreversible airflow limitation and respiratory muscle dysfunction. Bioactive lipid mediators such as prostaglandins, leukotrienes, and specialized pro-resolving mediators (SPMs) play critical roles in regulating inflammation, yet their relationship with diaphragmatic performance in COPD remains poorly understood. This case-control study investigated the association between circulating lipid mediators and diaphragmatic function in 40 male COPD patients and 40 age- and sex-matched healthy controls. All participants underwent clinical assessment, spirometry, C-reactive protein (CRP) measurement, blood sampling for lipid mediator profiling-including polyunsaturated fatty acid (PUFA)-derived metabolites-and diaphragmatic ultrasound evaluation of excursion and thickening fraction (TF). COPD patients exhibited significantly impaired diaphragmatic function and elevated pro-inflammatory lipid mediators compared with controls. Receiver operating characteristic (ROC) analysis identified Prostaglandin E2 (PGE₂) (area under the curve [AUC] = 0.826), Thromboxane B2 (TXB₂) (AUC = 0.832), and Leukotriene B4 (LTB₄) (AUC = 0.737) as strong diagnostic biomarkers for COPD. Among SPMs, RvD1 correlated positively with diaphragmatic excursion (r = .62) and TF (r = .58), Lipoxin A4 (LXA₄) correlated with Forced Expiratory Volume in one second (FEV₁) (r = .66), and Protectin DX (PDX) showed an inverse association with the COPD Assessment Test (CAT) score (r = -.54). Leukotriene E4 (LTE₄) and Leukotriene D4 (LTD₄) were negatively associated with diaphragmatic performance, while CRP levels inversely correlated with ultrasound parameters. Diaphragmatic TF demonstrated high sensitivity (90%) and specificity (92%) in predicting severe exacerbations. These findings suggest that lipid mediator imbalance contributes to diaphragmatic dysfunction in COPD and that combining lipidomic profiling with diaphragmatic ultrasound may offer a promising approach for assessing systemic inflammation and respiratory muscle performance in male COPD patients.

IntroductionNon-specific low back pain (NSLBP) is one of the leading causes of disability worldwide. Emerging evidence suggests that altered diaphragmatic function may be associated with lumbar pain, impaired trunk stabilisation and functional disability. Manual diaphragmatic techniques have been proposed as an intervention to modulate diaphragmatic tension, mobility and neuromyofascial relationships; however, their effectiveness has not yet been synthesised using rigorous systematic review methods.Methods and analysisThis protocol follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidance and has been prospectively registered in PROSPERO. Randomised controlled trials evaluating manual techniques specifically applied to the diaphragm in adults with NSLBP will be eligible. The primary outcomes will include pain intensity and functional disability; secondary outcomes will include lumbar mobility, respiratory function, quality of life and adverse events. Searches will be performed in PubMed/MEDLINE, Cochrane CENTRAL, PEDro, CINAHL, Scopus, Embase and clinical trial registries without language or date restrictions. Two reviewers will independently perform study selection, data extraction and risk-of-bias (RoB) assessment using the Cochrane RoB 2 tool. Where appropriate, a random-effects meta-analysis will be conducted; the certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach. Substantial clinical and methodological heterogeneity is anticipated across trials, which may limit the feasibility of quantitative data pooling.Ethics and disseminationAs this study uses data from previously published trials, ethical approval is not required. Findings will be disseminated through peer-reviewed publication, conference presentations and a plain-language summary for clinical stakeholders.PROSPERO registrationCRD420251172616.

ABSTRACT Background Weakness in respiratory muscles following a stroke may hinder the regulation of intra-abdominal pressure, potentially escalating the risk and severity of urinary incontinence (UI). A thorough understanding of how respiratory muscle strength and diaphragm function relate to UI in stroke patients is essential for comprehensive clinical assessment. Objectives This study aimed to explore the connection between maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), diaphragm function, and symptoms of urinary incontinence in stroke patients. Methods Fifty stroke patients (mean age 60.16 ± 9.56 years; 74% male) participated in the study. Respiratory muscle strength was assessed through standardized measurements of MIP and MEP. Endurance was evaluated with the Inspiratory Threshold Load (ITL) test. The effect of UI on quality of life was assessed using the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Diaphragm function was measured with specific tests based on the Dynamic Neuromuscular Stabilization (DNS) method. Differences between symptomatic and asymptomatic groups were analyzed using Pearson correlation, independent t-tests, Mann-Whitney U tests, and chi-square tests. Results Significant negative correlations were found between MIP and ITL scores and the severity of urinary incontinence (p < 0.001), while MEP exhibited weaker but still significant correlations (p < 0.05). Patients with urinary incontinence demonstrated significantly reduced diaphragm function compared to their asymptomatic counterparts (p < 0.01). Conclusions In individuals with stroke, diminished respiratory muscle strength, particularly diaphragm dysfunction, is linked to increased severity of UI. These findings highlight the necessity of evaluating respiratory muscle function in this population. Registration No NCT07048210

To evaluate the role of diaphragmatic ultrasound as a mortality predictor in acute exacerbation of chronic obstructive pulmonary disease (AECOPD), compared to the DECAF and BAP65 scoring systems. The diaphragm is the primary muscle of respiration and is often compromised during AECOPD. Bedside ultrasound offers a non-invasive method to assess diaphragmatic function. Early identification of patients at high risk of mortality upon presentation may aid in appropriate triage and management. This observational pilot study included 50 patients presenting to the emergency department with AECOPD. For each patient, the BAP65 score (Blood urea nitrogen, altered mental status, Pulse, Age ≥ 65), DECAF score (Dyspnea, Eosinopenia, Consolidation, Acidemia, Atrial fibrillation), diaphragmatic thickness fraction (diTF), and diaphragmatic excursion (diEX) were recorded at presentation. Of the 63 patients initially enrolled, 50 completed the study, with a predominance of male participants. Mortality occurred in 16% of cases. Deceased patients were significantly more likely to have comorbidities such as diabetes mellitus, hypertension, atrial fibrillation, ischemic heart disease, cardiomyopathy, cerebrovascular stroke, chronic kidney disease, and reliance on home oxygen therapy (P < 0.05). Receiver operating characteristic (ROC) analysis identified cutoff values for each predictor: BAP65 ≥ 5, DECAF ≥ 3, diTF ≤ 21%, and diEX ≤ 2.5 cm. Corresponding area under the curve (AUC) values were: BAP65, 0.833, CI = 0.621 to 1.000; DECAF, 0.976, CI = 0.933 to 1.000; diTF, 0.848, CI = 0.670 to 1.026; and diEX, 0.884, CI = 0.787 to 0.981. Spearman’s rank correlation revealed a strong negative correlation between diEX and DECAF (r = -0.771, CI= -0.862–-0.628, p < 0.001), and between diEX and BAP65 (r = -0.626, CI = -0.757–-0.448, p < 0.001). Moderate negative correlation was also observed between diTF and DECAF (r = -0.451, CI = 0.616–-0.241, p < 0.001), and weak negative correlation between diTF and BAP65 (r = -0.341, CI =-0.570–-0.069, p = 0.01). However, these finding should be interpreted with caution due to small sample size. Diaphragmatic ultrasound is a rapid and reliable tool for predicting mortality in patients with AECOPD presenting to the emergency department. It demonstrates comparable or superior predictive value to established scoring systems such as BAP65 and DECAF. However, this finding should be interpreted with caution and further studies with larger sample sizes are warranted to validate these findings.

Introduction: Body composition analysis measured with bioelectrical impedance analysis (BIA) is a method which has been frequently used in body composition assessment. The goal of this research is to determine the correlation of the derived measurements with the help of BIA with the strength of peripheral and inspiratory muscles as well as with the diaphragm’s function and thickness in healthy population. Participants and methods: Participants in this research were healthy individuals. They were tested on body composition with the help of bioelectrical impedance on Tanita MC-780MA device, maximal inspiratory pressure (MIP) with the POWERbreathe device, dynamometry of forearm muscle flexor and tibia extensor with the help of a dynamometer as well as ultrasound evaluation of diaphragm’s function. Results: The study sample consisted of a total of 50 participants, including 31 females (62%) and 19 males (38%) with a mean age of 41 years. The results have proved that the strength of peripheral and inspiratory muscles together with the diaphragm’s thickness and mobility are in strong correlation with muscle mass, sarcopenic index and phase angle measured by BIA. Conclusion: Bioelectrical impedance analysis is a reliable and practical method for assessing body composition and detecting early signs of muscle dysfunction. The established associations with muscle strength and diaphragmatic function highlight its potential as a simple screening tool for maintaining muscular health in clinical and preventive settings.

Background: Gastroesophageal reflux disease (GERD) is characterized by impaired lower esophageal sphincter (LES) pressure and diaphragmatic dysfunction. Conventional pharmacological therapy often fails to fully control symptoms, prompting interest in physiotherapy-based interventions. Objectives: To review clinical evidence on inspiratory muscle training (IMT), modified IMT, diaphragmatic breathing exercises (DBE), biofeedback training, myofascial release (MFR), and aerobic exercise in GERD management. Methodology: The literature review was drafted using Preferred Reporting Items for Systematic Reviews and Meta analysis protocols with appropriate modifications for purposes of narrative review. For this review all relevant information was identified using Google Scholar, PubMed, Science Direct, Cochrane library and Scopus. A literate review was performed. Search words were GERD, respiratory training, diaphragm, anti-reflux. Total 7 articles were included in this literature review. Randomized controlled trials and comparative studies published between 2012 and 2021 were analyzed. Sample sizes ranged from 30 to 50 participants, with outcomes measured via LES manometry, GERD symptom scores, and quality of life indices. Results: Inspiratory muscle increased LES pressure and reduced transient relaxations. Diaphragmatic breathing exercise and biofeedback training improved reflux symptoms and reduced belching. Diaphragm myofascial release enhanced GERD symptom scores. Aerobic exercise improved overall quality of life, while Diaphragmatic breathing more effectively increased LES pressure (Ahmadi, 2021). Conclusion: Physiotherapy interventions targeting diaphragmatic function consistently demonstrate improvements in LES competence, reflux symptoms, and patient-reported outcomes. These approaches are safe, low-cost adjuncts to pharmacological therapy. Larger multicenter RCTs are needed to confirm long-term efficacy.

Postoperative recovery following lung cancer surgery can be challenging owing to various cardiorespiratory complications. Pulmonary rehabilitation is crucial during both the preoperative and postoperative periods. However, because of limited resources and accessibility, innovative approaches are necessary to improve rehabilitation outcomes. This study aimed to evaluate the effectiveness of the RehabLung App, a novel AI-based mobile application integrating vision recognition, gamified feedback, and web-based patient management to support personalized lung rehabilitation through telerehabilitation and real-time monitoring. This study outlines the protocol for a randomized controlled trial involving patients with lung cancer undergoing thoracic surgery. Assessor-blinded (single-blind), two-arm, parallel-group randomized controlled trial (1:1 allocation) conducted at a single medical center. The intervention will include individualized exercise prescriptions delivered five times per week for 8 weeks via the App, which adapts based on weekly assessments of clinical parameters and real-time performance data. Primary outcomes include forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), as well as cardiopulmonary fitness assessed at baseline and at postoperative weeks 5 and 8. Secondary outcomes include respiratory muscle strength, diaphragmatic function, and user satisfaction, which are evaluated using a custom questionnaire informed by technology acceptance models. In addition, clinically meaningful endpoints will be collected, including morbidity, mortality, and length of stay. Frailty will be assessed preoperatively using the Clinical Frailty Scale, and validated patient-reported outcomes (EORTC QLQ-C30) will be administered to evaluate quality of life and symptom burden. The study has been approved by the Institutional Review Board at National Cheng Kung University Hospital (A-ER-111-055). We hypothesize that patients using the RehabLung App may demonstrate improvements in pulmonary function, exercise tolerance, diaphragmatic function, and rehabilitation adherence compared with those receiving standard care. The system's real-time feedback and risk alerts may facilitate timely intervention and could potentially improve engagement. The implementation of the RehabLung App in lung cancer surgery care may enhance the effectiveness and accessibility of pulmonary rehabilitation. This protocol describes an AI-enhanced telerehabilitation system that may support individualized recovery strategies and could potentially improve both clinical outcomes and patient engagement. Registration Date;2024,09,19; ClinicalTrials.gov (Identifier: NCT06600503).