Background: Patient–ventilator asynchrony (PVA) is a common problem in patients undergoing invasive mechanical ventilation (MV) in the intensive care unit (ICU), and may accelerate lung injury and diaphragm mis-contraction. The impact of PVA on clinical outcomes has not been systematically evaluated. Effective interventions (except for closed-loop ventilation) for reducing PVA are not well established. Methods: We performed a systematic review and meta-analysis to investigate the impact of PVA on clinical outcomes in patients undergoing MV (Part A) and the effectiveness of interventions for patients undergoing MV except for closed-loop ventilation (Part B). We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, ClinicalTrials.gov, and WHO-ICTRP until August 2020. In Part A, we defined asynchrony index (AI) ≥ 10 or ineffective triggering index (ITI) ≥ 10 as high PVA. We compared patients having high PVA with those having low PVA. Results: Eight studies in Part A and eight trials in Part B fulfilled the eligibility criteria. In Part A, five studies were related to the AI and three studies were related to the ITI. High PVA may be associated with longer duration of mechanical ventilation (mean difference, 5.16 days; 95% confidence interval [CI], 2.38 to 7.94; n = 8; certainty of evidence [CoE], low), higher ICU mortality (odds ratio [OR], 2.73; 95% CI 1.76 to 4.24; n = 6; CoE, low), and higher hospital mortality (OR, 1.94; 95% CI 1.14 to 3.30; n = 5; CoE, low). In Part B, interventions involving MV mode, tidal volume, and pressure-support level were associated with reduced PVA. Sedation protocol, sedation depth, and sedation with dexmedetomidine rather than propofol were also associated with reduced PVA. Conclusions: PVA may be associated with longer MV duration, higher ICU mortality, and higher hospital mortality. Physicians may consider monitoring PVA and adjusting ventilator settings and sedatives to reduce PVA. Further studies with adjustment for confounding factors are warranted to determine the impact of PVA on clinical outcomes. Trial registration protocols.io (URL: https://www.protocols.io/view/the-impact-of-patient-ventilator-asynchrony-in-adu-bsqtndwn, 08/27/2020).

Objective We aimed to determine whether enhanced physical rehabilitation following intensive care unit (ICU) discharge improves activities-of-daily-living function, quality of life (QOL) and mortality among patients who received mechanical ventilation in the ICU. Design Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data sources MEDLINE, Embase, CENTRAL, PEDro and WHO International Clinical Trials Registry Platform searched through January 2019. Eligibility criteria for selecting studies We included randomised controlled trials assessing the effect of post-ICU rehabilitation designed to either commence earlier and/or be more intensive than the protocol employed in the control group. Only adults who received mechanical ventilation for >24 hours were included. Data extraction and synthesis Two independent reviewers extracted data and assessed risk of bias. Standard mean differences (SMDs) with 95% CIs were calculated for QOL, and pooled risk ratios (RRs) with 95% CIs are provided for mortality. We assessed heterogeneity based on I² and the certainty of evidence based on the GRADE approach. Results Ten trials (enrolling 1110 patients) compared physical rehabilitation with usual care or no intervention after ICU discharge. Regarding QOL, the SMD (95% CI) between the intervention and control groups for the physical and mental component summary scores was 0.06 (–0.12 to 0.24) and −0.04 (−0.20 to 0.11), respectively. Rehabilitation did not significantly decrease long-term mortality (RR 1.05, 95% CI 0.66 to 1.66). The analysed trials did not report activities-of-daily-living data. The certainty of the evidence for QOL and mortality was moderate. Conclusions Enhanced physical rehabilitation following ICU discharge may make little or no difference to QOL or mortality among patients who received mechanical ventilation in the ICU. Given the wide CIs, further studies are needed to confirm the efficacy of intensive post-ICU rehabilitation in selected populations. PROSPERO registration number CRD42017080532.

Previous systematic review and meta-analysis indicates that rehabilitation within a week of intensive care unit (ICU) admission benefits physical function in critically ill patients. This updated systematic review and meta-analysis aim to clarify effects of initiating rehabilitation within 72 h of ICU admission on long-term physical, cognitive, and mental health. We systematically searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for randomized controlled trials (RCTs) between April 2019 and November 2022 to add to the previous review. Two investigators independently selected and extracted data. Pooled effect estimates for muscle strength, cognitive function, mental health after discharge, and adverse events were calculated. Evidence certainty was assessed via Grading of Recommendations, Assessment, Development, and Evaluations. Eleven RCTs were included in the meta-analysis. Early rehabilitation may improve muscle strength (three trials; standard mean difference [SMD], 0.16; 95% confidence interval [CI], −0.04–0.36) and cognitive function (two trials; SMD, 0.54; 95% CI, −0.13–1.20). Contrastingly, early mobilization showed limited impact on mental health or adverse events. In summary, initiating rehabilitation for critically ill patients within 72 h may improve physical and cognitive function to prevent post-intensive care syndrome without increasing adverse events. The effect on mental function remains uncertain.

Several recent studies have suggested that the early mobilization of mechanically ventilated patients in the intensive care unit is safe and effective. However, in these studies, few patients reached high levels of active mobilization, and the standard of care among the studies has been inconsistent. The incidence of adverse events during early mobilization is low. Its importance should be considered in the context of the ABCDE bundle. Protocols of early mobilization with strict inclusion and exclusion criteria are needed to further investigate its contributions.

Considering the current coronavirus disease (COVID-19) pandemic, telerehabilitation may be a viable first-line option for patients with respiratory tract disease. To date, there has been no systematic review on telerehabilitation for respiratory tract diseases, including COVID-19. Therefore, this scoping review aimed to determine what telerehabilitation for patients with respiratory tract diseases consists of, how safe telerehabilitation is for patients with respiratory tract diseases, and how feasible telerehabilitation is for hospitalized patients with COVID-19. In May 2020, we conducted a search of the following publication databases on the use of telerehabilitation in the treatment of respiratory tract diseases: Medical Literature Analysis and Retrieval System Online, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Literature, and Physiotherapy Evidence Database. Of the 208 articles identified, 23 studies were subsequently included in this scoping review. In 22 of the included studies, subjects had stable COPD and underwent telerehabilitation at home. The final included study was a case series of subjects with severe acute respiratory syndrome coronavirus 2 infection who underwent telerehabilitation in-hospital. Most telerehabilitation programs consisted of aerobic exercises using a cycle ergometer or a treadmill, walking, and muscle-strengthening exercises. The reported number of adverse events was low, and most studies reported that the average session adherence rate was > 70%. The majority of the telerehabilitation programs included a face-to-face rehabilitation assessment. Our findings indicate that, in its current state, telerehabilitation may be safe and feasible and may lead to reduced face-to-face rehabilitation therapy; in addition, remote rehabilitation assessment should be considered during the COVID-19 pandemic. Further research that targets a more diverse range of respiratory tract diseases and considers telerehabilitation in a hospital setting is required.