Early mobilization, breathing exercises and chest wall oscillation in patients with bilateral pneumonia disease in the intensive care unit: a randomized clinical trial.

BACKGROUND: The aim of this study was to evaluate the impact of three physiotherapy interventions on respiratory function, oxygenation, airway clearance, and hemodynamic stability in intensive care unit (ICU) patients diagnosed with bilateral pneumonia. METHODS: This prospective, randomized controlled clinical trial included 102 ICU patients (52 men and 50 women) with respiratory failure due to bilateral pneumonia. Participants were randomly assigned to one of three intervention groups: (1) chest wall oscillation combined with breathing exercises, (2) chest wall oscillation alone, or (3) early mobilization. A total of 488 physiotherapy sessions were performed. Primary outcomes included fraction of inspired oxygen (FiO₂), oxygen flow, and cough productivity; hemodynamic parameters were also assessed. Randomization was conducted using a computer-generated sequence. The breathing exercises included diaphragmatic and mixed breathing techniques, combined with inhalation and exhalation synchronized with active limb and trunk movements. Chest wall oscillation was performed using a high-frequency (16 Hz) vest to facilitate secretion clearance. Early mobilization involved assisting the patient into an upright sitting or standing position. RESULTS: Early mobilization and the combined intervention (chest wall oscillation with breathing exercises) significantly improved oxygenation parameters and airway clearance compared to chest wall oscillation alone, likely due to improved ventilation-perfusion matching and secretion mobilization. All interventions were hemodynamically well tolerated. Early mobilization led to the most substantial reduction in FiO₂ requirements. CONCLUSIONS: Active or combined physiotherapy interventions were more effective than passive techniques in improving respiratory outcomes in ICU patients with bilateral pneumonia. This study contributes novel data by evaluating a specific combination of early mobilization, chest wall oscillation, and breathing exercises in ICU patients with bilateral pneumonia in the acute stage - an area previously underrepresented in clinical trials, particularly in our regional context. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT06912308. Ethics approval BE256 (20230929).