{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T15:04:21Z","timestamp":1789311861222,"version":"build-2803163510"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Prolonged immobilization and invasive mechanical ventilation promote ICU-acquired weakness, delayed ventilator liberation, and poor long-term outcomes. We evaluated a structured respiratory physiotherapy and early mobilization pathway in a real-world ICU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We conducted a prospective before\u2013after study of critically ill adults admitted to ASST Valcamonica ICU, Italy, from January 2022 to December 2025. Subjects\u00a0treated before implementation (2022\u20132023;\n                      <jats:italic toggle=\"yes\">n =<\/jats:italic>\n                      602) were compared with those treated after implementation (2024\u20132025;\n                      <jats:italic toggle=\"yes\">n =<\/jats:italic>\n                      646). The intervention included respiratory physiotherapy, secretion management, early mobilization, progressive verticalization, assisted ambulation, and individualized ICU rehabilitation. Primary outcomes were ventilation\u00a0duration and ventilator-free days at day 28. Secondary outcomes included ICU-acquired weakness, electromyography (EMG)-confirmed neuromuscular dysfunction, ICU and hospital stay, discharge disposition, and long-term survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Implementation of the physiotherapy pathway increased rehabilitation exposure and early mobilization. Physiotherapy assessment within 48 h increased from 18.6% to 82.4% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), and mobilization within 72 h from 21.3% to 74.8% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Duration of invasive ventilation\u00a0decreased from 8 [4\u201315] to 5 [3\u201310] days (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002), while ventilator-free days increased. ICU stay decreased from 11 [6\u201321] to 8 [5\u201315] days (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). ICU-acquired weakness decreased from 31.4% to 20.7% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), and EMG-confirmed neuromuscular dysfunction from 15.1% to 9.8% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .005). Ventilator-associated pneumonia and tracheostomy rates were also reduced. Mortality through 180\u2009days was lower in the post-intervention cohort (41.9% vs 31.9%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001). In Cox analysis censored at 180\u2009days, structured physiotherapy implementation (adjusted hazard ratio [HR] 0.69, 95% CI: 0.56\u20130.85,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001) and mobilization within 72 h (adjusted HR 0.78, 95% CI: 0.63\u20130.97,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02) were independently associated with lower mortality risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Structured ICU physiotherapy and early mobilization were associated with shorter duration of invasive ventilation, fewer neuromuscular complications, better functional recovery, and lower 180-day mortality; given the before\u2013after design, these are associations, not causal effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19433654261479902","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:26:46Z","timestamp":1789054006000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Respiratory Physiotherapy and Mobilization in Mechanically Ventilated ICU Patients: A Before\u2013After Study of Ventilation, ICU Weakness, and Survival Outcomes"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3713-3546","authenticated-orcid":false,"given":"Alberto","family":"Corona","sequence":"first","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Bona","sequence":"additional","affiliation":[{"name":"Drs. Bona, Ferrari, Mai, Moretti, and Stoffler are affiliated with Physiotherapy and Rehabilitation Service ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Zendra","sequence":"additional","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Capone","sequence":"additional","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Zanotti","sequence":"additional","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Simoncini","sequence":"additional","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Richini","sequence":"additional","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemente","family":"Santorsola","sequence":"additional","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Celli","sequence":"additional","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Fiuman\u00f2","sequence":"additional","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariachiara","family":"Michelini","sequence":"additional","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Gatti","sequence":"additional","affiliation":[{"name":"Drs. Corona, Zendra, Capone, Zanotti, Simoncini, Richini, Santorsola, Celli, Fiuman\u00f2, Michelini, and Gatti are affiliated with Anaesthesia &amp; Intensive Care Department, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Drs. Bona, Ferrari, Mai, Moretti, and Stoffler are affiliated with Physiotherapy and Rehabilitation Service ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Mai","sequence":"additional","affiliation":[{"name":"Drs. Bona, Ferrari, Mai, Moretti, and Stoffler are affiliated with Physiotherapy and Rehabilitation Service ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Moretti","sequence":"additional","affiliation":[{"name":"Drs. Bona, Ferrari, Mai, Moretti, and Stoffler are affiliated with Physiotherapy and Rehabilitation Service ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Guarinoni","sequence":"additional","affiliation":[{"name":"Dr. Guarinoni and Zanini are affiliated with Department of Nursing and Healthcare Professions, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Stoffler","sequence":"additional","affiliation":[{"name":"Drs. Bona, Ferrari, Mai, Moretti, and Stoffler are affiliated with Physiotherapy and Rehabilitation Service ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliana","family":"Zanini","sequence":"additional","affiliation":[{"name":"Dr. Guarinoni and Zanini are affiliated with Department of Nursing and Healthcare Professions, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Pierre","family":"Ramponi","sequence":"additional","affiliation":[{"name":"Dr. Ramponi is affiliated with Medical Healthcare Directorate, ASST Valcamonica, Breno, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011802"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318232da75"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1553"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000040"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181fd66e5"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0993-7"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60658-9"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4612-0"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0130722"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31827ca637"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jphys.2016.10.011"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-024-07532-2"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-014-0658-y"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-018-1998-9"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005285"},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.22.2859"},{"key":"e_1_3_3_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181b6ef67"},{"key":"e_1_3_3_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(11)70178-8"},{"key":"e_1_3_3_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2015.05.024"},{"key":"e_1_3_3_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.278481"},{"key":"e_1_3_3_22_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2209083"},{"key":"e_1_3_3_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2016.45"},{"key":"e_1_3_3_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2017.165"},{"key":"e_1_3_3_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.17687"},{"key":"e_1_3_3_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jshs.2018.09.009"},{"key":"e_1_3_3_27_1","first-page":"6","article-title":"Position statement. Part one: immune function and exercise","volume":"17","author":"Walsh NP","year":"2011","unstructured":"26.Walsh NP, , Gleeson M, , Shephard RJ, et al. Position statement. Part one: immune function and exercise. Exerc Immunol Rev 2011;17:6\u201363; doi: 21446352","journal-title":"Exerc Immunol Rev"},{"key":"e_1_3_3_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1301372"},{"key":"e_1_3_3_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000001227"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654261479902","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19433654261479902","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654261479902","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T14:21:41Z","timestamp":1789309301000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19433654261479902"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":28,"alternative-id":["10.1177\/19433654261479902"],"URL":"https:\/\/doi.org\/10.1177\/19433654261479902","relation":{},"ISSN":["1943-3654","1943-3654"],"issn-type":[{"value":"1943-3654","type":"print"},{"value":"1943-3654","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"19433654261479902"}}