Early Respiratory Physiotherapy and Mobilization in Mechanically Ventilated ICU Patients: A Before–After Study of Ventilation, ICU Weakness, and Survival Outcomes

Background: 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. Methods: We conducted a prospective before–after study of critically ill adults admitted to ASST Valcamonica ICU, Italy, from January 2022 to December 2025. Subjects treated before implementation (2022–2023; n = 602) were compared with those treated after implementation (2024–2025; n = 646). The intervention included respiratory physiotherapy, secretion management, early mobilization, progressive verticalization, assisted ambulation, and individualized ICU rehabilitation. Primary outcomes were ventilation duration 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. Results: Implementation of the physiotherapy pathway increased rehabilitation exposure and early mobilization. Physiotherapy assessment within 48 h increased from 18.6% to 82.4% ( P < .001), and mobilization within 72 h from 21.3% to 74.8% ( P < .001). Duration of invasive ventilation decreased from 8 [4–15] to 5 [3–10] days ( P = .002), while ventilator-free days increased. ICU stay decreased from 11 [6–21] to 8 [5–15] days ( P < .001). ICU-acquired weakness decreased from 31.4% to 20.7% ( P < .001), and EMG-confirmed neuromuscular dysfunction from 15.1% to 9.8% ( P = .005). Ventilator-associated pneumonia and tracheostomy rates were also reduced. Mortality through 180 days was lower in the post-intervention cohort (41.9% vs 31.9%, P = .001). In Cox analysis censored at 180 days, structured physiotherapy implementation (adjusted hazard ratio [HR] 0.69, 95% CI: 0.56–0.85, P = .001) and mobilization within 72 h (adjusted HR 0.78, 95% CI: 0.63–0.97, P = .02) were independently associated with lower mortality risk. Conclusions: 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–after design, these are associations, not causal effects.