International Journal of Nursing Research

Objective To evaluate the clinical efficacy of a standardized stepwise rehabilitation protocol in mechanically ventilated patients admitted to the intensive care unit (ICU) and to provide evidence for developing individualized rehabilitation strategies. Methods Ninety mechanically ventilated patients admitted to the ICU of The First Affiliated Hospital of Xi’an Jiaotong University between October 2022 and May 2023 were enrolled. Patients were randomly assigned to either control group receiving routine lCU rehabilitation care or an experimental group receiving astandardized stepwise early-rehabilitation protocol initiated within 24 h of intubation. Control group: received routine ICU rehabilitation care aimed at preventing complications of bed rest and joint contracture. After hemodynamic stabilization, patients underwent active or passive limb joint mobilization in bed, 20–30 min per session, 3 times daily; activity was progressively increased until out-of-bed mobilization, weaning, and ICU discharge. Experimental group based on the concept of early rehabilitation therapy, patients underwent systematic assessment within 24 h of intubation once vital signs were stable, followed by implementation of a standardized stepwise early-rehabilitation protocol. Outcomes were compared between groups on intervention days 3, 5, and 7, and included: oxygenation index (PaO₂/FiO₂), incidence of ICU-acquired weakness (ICU-AW), ventilator-associated pneumonia (VAP), delirium, duration of mechanical ventilation, ICU length of stay, re-intubation rate, and nursing-related adverse events. Results Oxygenation index: Significant time effects and interaction effects favoring the experimental group were observed on days 5 and 7 (P < 0.05). Mechanical ventilation Duration was shorter in the experimental group (6.45 ± 1.78 d) than in the control group (9.17 ± 2.09 d) (P < 0.05). Re-intubation: 0 % in the experimental group versus 6.67 % in the control group (P < 0.05). ICU stay: Length of stay was reduced in the experimental group (10.78 ± 3.48 d) compared with the control group (15.23 ± 3.29 d) (P < 0.05).Incidence of ICU-AW: 2.22 % in the experimental group versus 17.78 % in the control group (P < 0.05). Delirium: 0 % in the experimental group versus 13.33 % in the control group (P < 0.05). No cases of VAP or nursing-related adverse events occurred in either group. Conclusion A standardized stepwise rehabilitation protocol can effectively improve oxygenation, shorten both mechanical ventilation duration and ICU length of stay, reduce re-intubation rates, and decrease the risks of ICU-acquired weakness and delirium in mechanically ventilated ICU patients, thereby facilitating rapid recovery. The protocol is clinically effective and merits broader application.

Standardization; Stepwise; Pulmonary rehabilitation; Mechanical ventilation; Critical care nursing