Long-term bed rest or prolonged immobility can lead to serious complications in critically ill patients undergoing mechanical ventilation, such as ICU-acquired weakness (ICU-AW), cardiac circulatory system dysfunction, metobolic and mental disorders etc3–4. These complications not only prolong the duration of mechanical ventilation and ICU hospitalization, but also seriously impair the rehabilitation of patients’ body functions5–7. As one of the most common complications, ICU-AW is clinically manifested by limb paralysis, muscle atrophy and difficulty in ventilator weaning8. It has been reported that the incidence of ICU-AW among patients with mechanical ventilation could be 33%-82%9–10. ICU-AW also prolongs the time of ICU hospitalization, what’s worse, it decreases the patient’s life quality during 90 days after discharge11. Previous studies had followed up a queue of survivors of ARDS, finding that even 5 years after discharge, physical dysfunction failed to recover completely5. At present, no pharmacological therapy are recommended to prevent and treat ICU-AW12. The managements mainly focus on supportive care for patients.13
Recently, it is suggested that long-term bed-rest, the traditional nursing mode, should be changed among mechanical ventilation patients. Meanwhile, early mobilization (EM) is recommended in many guidelines as a preferable method to promote the recovery. Even though EM is thought to be feasible and beneficial for mechanical ventilation patients in the ICU14,15, it is poorly defined and previously only referred to early program of standing and walking training (rehabilitation) or simply moving patients’ limbs, etc.16.
Many studies have shown the effectiveness of EM, as it not only helps patients regain muscle strength, especially inspiratory muscle, which leads to better physical function17, 18, but also prolongs patients’ ventilator-free time and increases their ability to ambulate and to conduct daily activities 19. However, EM may also give rise to occasional side effects, such as increases of heart rate and respiratory rate and to minor adverse events, such as transient hypotension, oxygen desaturation, patient-ventilator asynchrony and agitation. Few studies reported that EM in AECOPD patients during hospitalization may increase the mortality and there are some risks and potential dangers such as unscheduled extubation24. The underlying cause may be that the critical conditions make these patients more vulnerable to accept EM.24.
Non-invasive ventilation provides an "intermediate" or "transitional" alternative of auxiliary ventilation between oxygen therapy and invasive ventilation, especially for respiratory failure in early stage or without emergent tracheal intubation indications26. Therefore, comparing with invasive ventilation patients, non-invasive ventilation patients may have better conditions and tolerance for EM, the safety of EM in non-invasive ventilation patients might be better. Moreover, interventions such as early and sustained mobilization may be key in deterring the progression to intubation and invasive mechanical ventilation in NIPPV patients. Hodgson26 even emphasized the safety of EM among patients with mechanical ventilation, and gave some suggestions on the safety standards: it is necessary to organize a multidisciplinary treatment team to ensure the safety and effectiveness of EM.
Many studies have demonstrated the feasibility and safety of EM for invasive mechanical ventilation ICU patients21 since EM can prevent ICU-AW by increasing the duration and level of active exercises and reducing the duration of ventilation and length of ICU stay28. However, few studies have reported whether EM has the similar effect for non-invasive ventilation population, especially NIPPV patients. To figure out this, we formed a multidisciplinary team including doctors, nurses and respiratory therapists in this study. Meanwhile, we assessed the patients’ conditions before EM to ensure the safety. This study aimed to investigate the feasibility and safety of EM in NIPPV patients and the effect of EM on the promotion of rehabilitation in patients with NIPPV in ICU. Therefore, we conducted a randomized controlled trail to investigate whether EM can prevent the ICU-AW, reduce the duration of (non-invasive) ventilation and the length of ICU stay, and improve the physical function among NIPPV patients.