[Construction and empirical study of an early exercise protocol based on the ICU mobility scale model for...

To investigate the clinical effectiveness of an early mobilization protocol based on the ICU mobility scale (IMS) movement model in intensive care unit (ICU) patients with difficult weaning from mechanical ventilation.

A quasi-experimental study design was adopted. Patients with difficult weaning admitted to the department of critical care medicine, the First Affiliated Hospital of Wannan Medical College, from February 2022 to February 2023 were assigned to the control group, while those admitted from March 2023 to March 2024 were allocated to the experimental group, all meeting predefined inclusion and exclusion criteria. The control group received conventional early rehabilitation activities, whereas the experimental group received an IMS model-based early mobilization protocol in addition to standard care. General demographic data, Medical Research Council (MRC), Barthel index score, and generalized anxiety disorder-7 (GAD-7) score at the time of enrollment and discharge, diaphragmatic ultrasound parameters (including diaphragm thickness, diaphragm thickening fraction, and diaphragm excursion) at the time of enrollment and 24 hours after extubation, and outcomes-related indicators of each group of patients were collected and compared.

A total of 52 patients with difficult weaning were enrolled, including 25 in the control group and 27 in the experimental group. No significant differences were observed between the two groups in terms of gender, age, or other baseline characteristics, indicating comparability. There were no statistically significant differences in MRC scores or Barthel index scores between the groups at enrollment. However, at ICU discharge, the experimental group showed significantly higher MRC scores (44.41±2.61 vs. 35.32±2.75) and Barthel index scores [45 (35, 45) vs. 40 (35, 45), both P < 0.05]. Regarding diaphragmatic ultrasound parameters, no significant differences were found between groups at baseline in diaphragm thickness, diaphragm thickening fraction, or diaphragm excursion. At discharge, the experimental group exhibited a significantly higher diaphragm thickening fraction 24 hours after extubation (%: 26.53 ± 3.74 vs. 24.31±3.71, P < 0.05) and greater diaphragm excursion (cm: 1.80±0.40 vs. 1.52±0.57, P < 0.05). In terms of anxiety status, there was no significant difference in GAD-7 scores between groups at enrollment; however, at discharge, the experimental group had a significantly lower GAD-7 score [12.0 (8.5, 17.0) vs. 16.0 (15.0, 17.0), P < 0.05]. For clinical outcomes, the experimental group had significantly shorter durations of mechanical ventilation (MV) [hours: 144.00 (116.00, 304.00) vs. 396.00 (240.50, 606.50)] and ICU length of stay [days: 12.00 (8.00, 24.00) vs. 24.00 (18.00, 41.50)], both P < 0.05. No significant differences were observed between the two groups in total hospital stay, 48-hour reintubation rate, 48-hour ICU readmission rate, or total hospitalization cost. The overall safety profile during the implementation of the mobilization protocol was favorable.

The early mobilization protocol based on the IMS model for ICU patients with difficulty in weaning can effectively enhance exercise capacity, improve diaphragmatic function, elevate self-care capacity, alleviate anxiety, and shorten the duration of MV and ICU length of stay.