Rehabilitating the diaphragm: an integrated approach to intensive care unit-acquired dysfunction in critical...

Improved survival in critical illness has increased recognition of intensive care unit (ICU) complications, particularly ICU-acquired weakness, which affects up to 25% of patients. Diaphragm involvement is common and contributes to prolonged ventilation, difficult weaning, and worse outcomes. Dysfunction arises from ventilator-induced injury, sepsis-related myopathy, or both. Although early mobilization and physiotherapy improve recovery, their effectiveness is often limited by respiratory muscle fatigue and dyspnea. Non-invasive ventilation (NIV) reduces the work of breathing, sustains spontaneous effort, and enhances exercise tolerance, thereby facilitating earlier and safer rehabilitation. This review summarizes the current understanding of the pathophysiology of ICU-acquired diaphragm dysfunction. It explores the role of NIV and other respiratory supports as an adjunct to physiotherapy aimed at optimizing recovery in critically ill patients.