Cardiopulmonary responses to neurophysiological facilitation of respiration in mechanically ventilated ICU patients
DOI:
https://doi.org/10.11603/ijmmr.2413-6077.2026.1.16456Keywords:
haemodynamic parameters, perioral pressure, intercostal stretch, respiratory therapy intervention, intensive care physiotherapyAbstract
Abstract. Mechanical ventilation is essential in acute illness but may lead to complications such as atelectasis and monotonousbreathing, whichphysiotherapistshelpcounterbyusingneurophysiologicalfacilitationtechniquestoenhance the respiratory function of unconscious and sedated patients. By exploring neurophysiological facilitation techniques, the study aimed to evaluate the immediate effects of perioral pressure and intercostal stretch on cardiopulmonary parameters in mechanically ventilated patients at the University of Benin Teaching Hospital. A randomised crossover experimental design was used, involving ten patients (5 males, 5 females; mean age 66.2 ± 8.5 years) who were haemodynamically stable but unconscious and ventilated. Cardiopulmonary variables including systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, oxygen saturation, and mean arterial pressure were measured before and after each neurophysiological facilitation techniques intervention using a standardised protocol. The results showed that perioral pressure significantly improved diastolic blood pressure (77.10 ± 9.01 to 79.30 ± 10.34 mmHg, p = 0.005), respiratory rate (26.40 ± 6.08 to 28.30 ± 6.60 breaths/min, p = 0.014), and mean arterial pressure (92.70 ± 10.70 to 94.00 ± 10.06 mmHg, p = 0.022). Intercostal stretch significantly increased respiratory rate (26.8 ± 6.07 to 28.2 ± 6.07 breaths/min, p < 0.001), while changes in systolic pressure, heart rate, and oxygen saturation were not statistically significant (p> 0.05). Gender did not influence the magnitude of changes in any cardiopulmonary parameter. The study established that neurophysiological facilitation techniques elicited beneficial acute effects on respiratory rate and haemodynamic parameters in mechanically ventilated patients and highlighted neurophysiological facilitation techniques as a practical adjunct to respiratory physiotherapy for improved cardiopulmonary stability in critically ill patients
Received: 13.01.2026 | Revised: 20.04.2026 | Accepted: 26.05.2026
References
Das S, Sikka G, Kumar P. Combined effect of expiratory rib cage compression technique and intercostal stretch technique on static lung compliance and hemodynamic parameters in mechanically ventilated patients. Int J Sci Healthc Res. 2025;10(4):170–80. DOI: 10.52403/ijshr.20250425 DOI: https://doi.org/10.52403/ijshr.20250425
Carabalí-Rivera JA, Salazar-Muñoz V, Villanueva-Londoño ED, González-Ruiz K, Arzayus-Patiño L. Respiratory muscle training in mechanically ventilated adult patients: Toward a precise prescription based on current evidence: A scoping review. J Clin Med. 2025;14(14):5058. DOI: 10.3390/jcm14145058 DOI: https://doi.org/10.3390/jcm14145058
Mankad D, Trivedi S, Bhatt JP. Role of proprioceptive neuromuscular facilitation techniques of respiration in mechanically ventilated patients – a systematic review of clinical evidence. Int J Health Sci Res. 2024;14(1):54–62.
DOI: 10.52403/ijhsr.20240108 DOI: https://doi.org/10.52403/ijhsr.20240108
Chowdhury KN. Effectiveness of intercostal stretch technique on pulmonary conditions: A narrative review. J Pulmonol Respir Res. 2024;8(2):48–52. DOI: 10.29328/journal.jprr.1001059 DOI: https://doi.org/10.29328/journal.jprr.1001059
Tong S, Yang Y, Li Y, Liu L, Chang W. Consequences in critically ill patients with prolonged mechanical ventilation after diaphragmatic stimulation techniques: A systematic review and meta-analysis. BMJ Open. 2025;15(9):e098814.
DOI: 10.1136/bmjopen-2025-098814 DOI: https://doi.org/10.1136/bmjopen-2025-098814
Bassi T, Rohrs E, Parfait M, Hannigan BC, Reynolds S, Mayaux J, et al. Restoring brain connectivity by phrenic nerve stimulation in sedated and mechanically ventilated patients. Commun Med. 2024;4:235. DOI: 10.1038/s43856-024-00662-0 DOI: https://doi.org/10.1038/s43856-024-00662-0
Azimi F, Nazari AM, Yadollahi F, Etemadifar S, Kheiri S, Masoudi R. The comparison of two types of physiotherapy techniques on selected weaning indices of patients requiring mechanical ventilation: A single-blind randomized controlled trial. Sci Rep. 2025;15:18489. DOI: 10.1038/s41598-025-03701-5 DOI: https://doi.org/10.1038/s41598-025-03701-5
Bickenbach J, Fritsch S, Cosler S, Simon Y, Dreher M, Theisen S, et al. Effects of structured protocolized physical therapy on the duration of mechanical ventilation in patients with prolonged weaning. J Crit Care. 2024;80:154491.
DOI: 10.1016/j.jcrc.2023.154491 DOI: https://doi.org/10.1016/j.jcrc.2023.154491
Xingyu X, Zhang D, Cheng S. Effects of pulmonary rehabilitation on respiratory function in mechanically ventilated patients: A systematic review and meta-analysis. BMC Pulm Med. 2025;25(1):4. DOI: 10.1186/s12890-024-03461-4 DOI: https://doi.org/10.1186/s12890-024-03461-4
The World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects [Internet]. [cited 2024 December 13]. Available from: https://www.wma.net/what-we-do/medical-ethics/ declaration-of-helsinki/
European Commission. Ethics and Data Protection [Internet]. 2021 July 5 [cited 2024 December 2]. Available from: https://ec.europa.eu/info/funding-tenders/opportunities/docs/2021-2027/horizon/guidance/ethics-and-data- protection_he_en.pdf
Jones B, Kenward MG. Design and analysis of cross-over trials. New York: Chapman & Hall/CRC; 2014. 438 P.
DOI: 10.1201/b17537 DOI: https://doi.org/10.1201/b17537
Thorat KD, Tungikar S, Lofvenmark I. Effectiveness of respiratory proprioceptive neuromuscular facilitation techniques on pulmonary functions in spinal cord injury patients: A randomized controlled trial. Int J Res Med Sci. 2024;12(7):2390–7. DOI: 10.18203/2320-6012.ijrms20241888 DOI: https://doi.org/10.18203/2320-6012.ijrms20241888
Salve A, Maghade S, Katke S, Prabhakar R, Lodhi MS. Effect of vertebral pressure and intercostal stretch techniques on respiratory rate, tidal volume, SpO₂ and heart rate among organophosphorus poisoning patients: An experimental study. Int J Health Sci Res. 2021;11(7):265–71. DOI: 10.52403/ijhsr.20210736 DOI: https://doi.org/10.52403/ijhsr.20210736
Jenkins TO, MacBean V, Poulsen MK, Karbing DS, Rees SE, Patel BV, et al. The metabolic cost of inspiratory muscle training in mechanically ventilated patients in critical care. Intensive Care Med Exp. 2023;11:41. DOI: 10.1186/ s40635-023-00522-6 DOI: https://doi.org/10.1186/s40635-023-00522-6
Kumar S, Pottur G, Mitra S, Kushwaha AK, Kuma P, Pal Singh S, et al. Correlation of dyspnea with age and SpO₂ levels in COVID-19 and effectiveness of neurophysiological facilitation in the management of dyspnea – a randomized clinical trial. Egyp J Phys Ther. 2020;4:25–31. DOI: https://doi.org/10.21608/ejpt.2020.41478.1017
Patel S, Prajapati H. Effect of neurophysiological facilitation of respiration on respiratory rate and chest expansion in children with spastic cerebral palsy – an experimental study. Int J Sci Res. 2021;10(3):1525–8. DOI: 10.21275/ sr21318132259 DOI: https://doi.org/10.21275/SR21318132259
Zhou Q, Zhang Y, Yao W, Liang S, Feng H, Pan H. Effects of proprioceptive neuromuscular facilitation combined with threshold inspiratory muscle training on respiratory function in neurocritical patients with weaning failure: A randomized controlled trial. Int J Rehabil Res. 2024;47(3):164–8. DOI: 10.1097/MRR.0000000000000627 DOI: https://doi.org/10.1097/MRR.0000000000000627
Nair A, Alaparthi GK, Krishnan S, Rai S, Anand R, Acharya V, et al. Comparison of diaphragmatic stretch technique and manual diaphragm release technique on diaphragmatic excursion in chronic obstructive pulmonary disease: A randomized crossover trial. Pulm Med. 2019;2019:6364376. DOI: 10.1155/2019/6364376 DOI: https://doi.org/10.1155/2019/6364376
Réginault T, Alejos RM, Coueron R, Burle JF, Boyer A, Frison E, et al. Impacts of three inspiratory muscle training programs on inspiratory muscles strength and endurance among intubated and mechanically ventilated patients with diffi ult weaning: A multicentre randomised controlled trial. J Intensive Care. 2024;12:28. DOI: 10.1186/s40560-024-00741-3 DOI: https://doi.org/10.1186/s40560-024-00741-3
de Medeiros AIC, Fuzari HKB, Rattesa C, Brandão DC, de Melo Marinho PÉ. Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: A systematic review. J Physiother. 2017;63(2):76–83. DOI: 10.1016/j.jphys.2017.02.016 DOI: https://doi.org/10.1016/j.jphys.2017.02.016
Etikan I, Musa SA, Alkassim RS. Comparison of convenience sampling andpurposive sampling. Am J Theor Appl Stat. 2016;5(1):1–4. DOI: 10.11648/j.ajtas.20160501.11 DOI: https://doi.org/10.11648/j.ajtas.20160501.11
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Chigozie Obaseki, Victor Okpakpa, Osayi Obarisiagbon, Prosper Chinahum Obasi

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.









