[Effects of early off-bed activity on respiratory mechanics in intensive care unit patients undergoing mechanical...

To investigate the effects of an early off-bed activity protocol on respiratory mechanics in intensive care unit (ICU) patients receiving invasive mechanical ventilation via endotracheal intubation.

A prospective randomized controlled trial was conducted. Adult patients admitted to the ICU of the Affiliated Hospital of Zunyi Medical University between January 2024 and October 2024, who were receiving invasive mechanical ventilation and undergoing early mobilization, were enrolled. Patients were randomly assigned to a control group or an experimental group using a random number table. The control group received conventional progressive early mobilization. The experimental group received early mobilization using a patient transfer device to move patients off the bed, followed by a series of activities. The two groups only differed in the intervention protocol; all other routine treatments and care were consistent. The gender, age, main diagnosis upon admission to the ICU, and acute physiology and chronic health evaluation(APACHE) of the two groups of patients were compared. Minute ventilation (MV), inspiratory tidal volume (MVi), expiratory tidal volume (MVe), respiratory rate of the ventilator (RR), airway resistance (Raw), dynamic lung compliance (Cdyn), work of breathing (WOB), mean airway pressure (Pm), peak inspiratory pressure (PIP), plateau pressure (Pplat), driving pressure (ΔP), and positive end expiratory pressure (PEEP) were compared between the two groups before the intervention and at 5, 10, 15, and 30 minutes after the intervention. The duration of invasive mechanical ventilation, ICU length of stay, and the 48-hour reintubation rate were also compared.

A total of 170 patients receiving invasive mechanical ventilation were initially enrolled; 11 dropped out during the study, resulting in 78 patients in the control group and 81 in the experimental group for final analysis. There were no significant differences in baseline characteristics, including gender, age, primary ICU diagnosis, APACHE score, or pre-intervention respiratory mechanics parameters between the two groups. Over the intervention time course, MV, MVi, MVe, RR, Raw, and Cdyn showed an increasing trend, while Raw and WOB showed a decreasing trend in both groups, with these changes being more pronounced in the experimental group. There were significant time, intervention, and interaction effects (all P < 0.01). However, there were no significant differences in Pm, PIP, Pplat, ΔP, or PEEP between the two groups at any post-intervention time point. The duration of invasive mechanical ventilation and ICU length of stay were significantly shorter in the experimental group compared to the control group [invasive mechanical ventilation time (hours): 84.21±32.08 vs. 121.94±59.24; ICU length of stay (days): 5.21±1.77 vs. 7.06±2.75; both P < 0.05]. But the 48-hour reintubation rate was not significantly different between the two groups.

Both conventional progressive early mobilization and early off-bed activity influence respiratory mechanics parameters in ICU patients undergoing mechanical ventilation, but early off-bed activity has a greater impact. Early off-bed activity did not increase airway pressure or cause airway injury. Furthermore, early off-bed activity better shortened the duration of invasive mechanical ventilation and ICU length of stay, proving to be safe and feasible.