Keywords
Mechanical ventilation
Ventilator-induced diaphragmatic dysfunction
Diaphragmatic ultrasound
Intensive care
Submitted : 2026-06-20
Accepted : 2026-07-05
Published : 2026-07-20
Abstract
Objective: To investigate the preventive effects of early pulmonary rehabilitation training on ventilator-induced diaphragmatic dysfunction (VIDD) in ICU mechanically ventilated patients and its impact on clinical outcomes. Methods: A prospective randomized controlled trial was conducted. A total of 82 mechanically ventilated patients admitted to the intensive care unit of a tertiary hospital from January 2025 to December 2025 were enrolled and randomly assigned to either the experimental group (n = 41) or the control group (n = 41) using a random number table. The control group received routine ICU care and an early mobilization protocol, while the experimental group received systematic early pulmonary rehabilitation training in addition to the control protocol. Ultimately, 75 patients completed the study. Diaphragm excursion (DE), diaphragmatic thickening fraction (DTF), maximum inspiratory pressure (MIP), duration of mechanical ventilation, ICU length of stay, incidence of VIDD, and adverse events were compared between the two groups. Results: On day 5 and day 7 of the intervention, DE and DTF in the experimental group were significantly higher than those in the control group (p < 0.05). MIP on day 7 was significantly higher in the experimental group than in the control group (p < 0.001). The experimental group had significantly shorter durations of mechanical ventilation (6.2 ± 2.1 days vs. 8.7 ± 3.4 days) and ICU stays (9.5 ± 3.2 days vs. 12.8 ± 4.6 days) compared to the control group (p < 0.001). The incidence of VIDD was significantly lower in the experimental group (15.8%, 6/38) than in the control group (40.5%, 15/37; p = 0.017). No significant difference was found in the incidence of adverse events between the two groups (p > 0.05). Conclusion: Early pulmonary rehabilitation training effectively improves diaphragmatic function, reduces the incidence of VIDD, shortens the duration of mechanical ventilation and ICU length of stay in mechanically ventilated patients, and demonstrates good safety.
References
Fu W, Guan L, Liu Q, et al., 2025, Ventilator-Induced Diaphragmatic Dysfunction: Pathophysiology, Monitoring, and Advances in Potential Treatment and Prevention. European Respiratory Review, 34(178): 250069.
Benli R, Yurdalan U, Yılmaz B, et al., 2024, Effect of Post-Extubation Inspiratory Muscle Training on Diaphragmatic Function in Mechanically Ventilated Patients: A Randomized Controlled Trial. Advances in Clinical and Experimental Medicine, 33(10): 1077–1085.
Khwaja S, Habib M, Gupta R, et al., 2025, Unraveling Ventilator-Induced Diaphragmatic Dysfunction: A Comprehensive Narrative Review on Pathogenesis, Diagnosis, and Management. Current Respiratory Medicine Reviews, 21(1): 1–15.
Wang S, Chen Y, Lin S, et al., 2025, Inspiratory Muscle Training Facilitates Liberation from Mechanical Ventilation in Subacute Critically Ill Patients: A Randomized Controlled Trial. Frontiers in Medicine, 11: 1503678.
Farley C, Newman A, Ho J, et al., 2025, The Effects of Inspiratory Muscle Training in Critically Ill Adults: A Systematic Review and Meta-Analysis. Journal of Intensive Care Medicine, 40(3): 238–252.
Liu H, Ni P, Li L, et al., 2024, Effect of Early Pulmonary Rehabilitation Combined with ESCAPE Bundled Nursing on Ventilator-Induced Diaphragmatic Dysfunction in ICU Patients Undergoing Invasive Mechanical Ventilation. Qilu Journal of Nursing, 30(10): 23–27.
Wang J, Li S, Zhang Y, et al., 2025, Relationship Between Mechanical Ventilation Duration and Diaphragmatic Function Recovery Under Integrated Rehabilitation Intervention. Chinese Journal of Integrated Traditional and Western Medicine Surgery, 31(1): 50–55.
Hao T, Cheng J, Li Q, et al., 2025, Effect of Phrenic Nerve Electrical Stimulation on Extubation Outcomes in ICU Mechanically Ventilated Patients: A Meta-Analysis. Chinese Journal of Respiratory and Critical Care Medicine, 24(1): 9–17.
Chen L, Zhao M, Sun T, et al., 2025, Effect of Early Out-of-Bed Activity on Diaphragmatic Function in ICU Mechanically Ventilated Patients. Chinese Journal of Nursing, 60(4): 456–462.
Lin X, Zhang M, Huang L, et al., 2024, Effect of Respiratory Muscle Training Combined with Lung Ultrasound Monitoring on Diaphragmatic Function and Weaning in Mechanically Ventilated Patients. Contemporary Nurse (First Issue), 31(3): 42–46.
Critical Care Rehabilitation Committee of the Chinese Rehabilitation Medical Association, 2025, Chinese Expert Consensus on Severe-Subacute Organ Rehabilitation – Pulmonary Rehabilitation Section. Chinese Journal of Rehabilitation Medicine, 40(7): 1–15.
Zhou W, Li S, He P, et al., 2025, Summary of Best Evidence for Diaphragmatic Rehabilitation in ICU Mechanically Ventilated Patients. Chongqing Medicine, 54(6): 1–6.
Tong S, Yang Y, Li Y, et al., 2025, Consequences in Critically Ill Patients with Prolonged Mechanical Ventilation After Diaphragmatic Stimulation Techniques: A Systematic Review and Meta-Analysis. Intensive and Critical Care Nursing, 86: 103789.
Dres M, Goligher E, Heunks L, et al., 2025, Monitoring and Preserving Diaphragmatic Function in Critically Ill Patients. Current Opinion in Critical Care, 31(2): 132–141.
He L, Zhou P, Zheng H, et al., 2025, Research Progress on Diaphragmatic Rehabilitation in Critically Ill, Mechanically Ventilated Patients. Chinese Journal of Nursing, 60(14): 1785–1791.
Ma J, Yang L, Han B, 2025, Monitoring and Rehabilitation of Diaphragmatic Dysfunction in Mechanically Ventilated Patients. Proceedings of the First Symposium on Clinical Medicine Application Development and Integrated Medical and Nursing Care: 15–20.
Li T, Zhang W, Xu J, et al., 2025, Effect of MDT-Assisted Early Graded Respiratory Rehabilitation Training on Respiration, Oxygenation, DE, and DTF in Mechanically Ventilated Patients. Nursing Research, 39(3): 510–515.
Rochester C, Singh S, Spruit M, et al., 2025, Respiratory Muscle Dysfunction in Older Critically Ill Patients: Implications for Rehabilitation. Critical Care Clinics, 41(4): 671–686.
Mitchell R, Davies A, Chen L, 2026, Rehabilitating the Diaphragm: An Integrated Approach to Intensive Care Unit-Acquired Dysfunction in Critical Illness: A Narrative Review. Annals of Clinical Care and Critical Care, 5(1): 25–36.
Zhang L, Wang F, Liu C, et al., 2025, Summary of Best Evidence for Diaphragmatic Function Training in Mechanically Ventilated Patients. Chinese Nursing Management, 25(8): 1275–1282.