With the increasing burden of chronic diseases, the population dependent on mechanical ventilation continues to grow, while traditional rehabilitation management faces challenges such as fragmented data, discontinuous care pathways, and poor adherence. Focusing on the need for integrated in-hospital and out-of-hospital management for patients with chronic disease who are dependent on mechanical ventilation, this article discusses the development and implementation of an intelligent respiratory rehabilitation platform. Based on its application in multiple scenarios, its role in optimizing rehabilitation pathways and improving continuity of care is analyzed. Current challenges, including data interoperability, standardization, the depth of intelligent application, and digital adaptation of both healthcare professionals and patients, are also discussed, in order to provide a reference for related practice.