Early Respiratory Physiotherapy and Mobilization in Mechanically Ventilated ICU Patients: A Before-After Study of Ventilation, ICU Weakness, and Survival Outcomes.

BACKGROUND

Prolonged immobilization and invasive mechanical ventilation promote ICU-acquired weakness, delayed ventilator liberation, and poor long-term outcomes. We evaluated a structured respiratory physiotherapy and early mobilization pathway in a real-world ICU.

METHODS

We conducted a prospective before-after study of critically ill adults admitted to ASST Valcamonica ICU, Italy, from January 2022 to December 2025. Subjects treated before implementation (2022-2023; n = 602) were compared with those treated after implementation (2024-2025; n = 646). The intervention included respiratory physiotherapy, secretion management, early mobilization, progressive verticalization, assisted ambulation, and individualized ICU rehabilitation. Primary outcomes were ventilation duration and ventilator-free days at day 28. Secondary outcomes included ICU-acquired weakness, electromyography (EMG)-confirmed neuromuscular dysfunction, ICU and hospital stay, discharge disposition, and long-term survival.

RESULTS

Implementation of the physiotherapy pathway increased rehabilitation exposure and early mobilization. Physiotherapy assessment within 48 h increased from 18.6% to 82.4% (P < .001), and mobilization within 72 h from 21.3% to 74.8% (P < .001). Duration of invasive ventilation decreased from 8 [4-15] to 5 [3-10] days (P = .002), while ventilator-free days increased. ICU stay decreased from 11 [6-21] to 8 [5-15] days (P < .001). ICU-acquired weakness decreased from 31.4% to 20.7% (P < .001), and EMG-confirmed neuromuscular dysfunction from 15.1% to 9.8% (P = .005). Ventilator-associated pneumonia and tracheostomy rates were also reduced. Mortality through 180 days was lower in the post-intervention cohort (41.9% vs 31.9%, P = .001). In Cox analysis censored at 180 days, structured physiotherapy implementation (adjusted hazard ratio [HR] 0.69, 95% CI: 0.56-0.85, P = .001) and mobilization within 72 h (adjusted HR 0.78, 95% CI: 0.63-0.97, P = .02) were independently associated with lower mortality risk.

CONCLUSIONS

Structured ICU physiotherapy and early mobilization were associated with shorter duration of invasive ventilation, fewer neuromuscular complications, better functional recovery, and lower 180-day mortality; given the before-after design, these are associations, not causal effects.