This single-center, controlled clinical trial investigates the efficacy and safety of an early multimodal rehabilitation program (MRP) versus a late MRP in mechanically ventilated adult patients in the intensive care unit (ICU).

The study addresses the significant complications of ICU-acquired weakness (ICUAW) and post-intensive care syndrome (PICS), which contribute to prolonged hospital stays, increased costs, and reduced quality of life. While early physical therapy has shown benefits, there is a lack of randomized controlled trials evaluating comprehensive multimodal therapy initiated very early.

The trial will include patients aged 18 or older with a Barthel score of 70 or more who require invasive mechanical ventilation for over 24 hours. Participants will be randomly assigned to either the early MRP group, beginning therapy within 24 hours of intubation, or the late MRP group, starting therapy 72 hours after intubation.

The multimodal rehabilitation program integrates interventions from physical, speech, respiratory, and occupational therapy teams. A key aspect of the MRP is its adaptive approach, adjusting therapy intensity and type based on the patient’s Richmond Agitation-Sedation Scale (RASS) score. Patients with lower RASS scores (deeper sedation) receive primarily passive interventions, such as passive range-of-motion exercises.

As patients become more alert (higher RASS scores), therapy progresses to more active exercises, including active-assisted and functional mobility activities. For patients with a RASS score of 2 or higher, occupational therapy incorporates behavioral and environmental modulation, utilizing calming techniques, sensory stimulation, cognitive tasks, and family education to support spatiotemporal orientation.

The primary outcome measure for efficacy is the duration of mechanical ventilation. Safety will be assessed by comparing the incidence of adverse events between the two groups. This trial aims to provide crucial evidence regarding the potential benefits and safety of initiating a comprehensive, adaptive rehabilitation program very early in the course of critical illness for mechanically ventilated patients.

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