Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients (original) (raw)
Related papers
2021
Background: Respiratory muscle weakness is one of the primary factors associated with difficulty of ventilatory weaning in critically ill patients. In this sense, inspiratory muscle training (IMT) is a possible facilitator of successful weaning. One of the devices used for IMT is the POWERbreathe®, because it provides a linear pressure load, with the possibility of gradual increments. The effectiveness of early IMT in this population is not yet well known. The aim of this study is to assess the effects of early IMT with a mechanical loading device on the weaning time of patients on invasive mechanical ventilation (primary outcome), respiratory muscle strength, length of stay in the intensive care unit and in the success rate of weaning (secondary outcomes).Methods: This randomised controlled trial, a single blind evaluation, will be conducted in the intensive care unit of a university hospital on 42 adults, who will be randomly and blindly categorised into the control group, compris...
BACKGROUND: Inspiratory muscle weakness is a consequence of mechanical ventilation that contributes to weaning failure in critical ill patients. Since 1980, case reports of inspiratory muscle training (IMT) in ventilated, difficult to be weaned patients have proposed that this training strategy is associated with successful weaning. OBJECTIVE: We evaluated the efficacy of the inspiratory muscle training on the weaning process. METHODS: We conducted a literature search in the following databases: PubMed, EMBASE, Scopus and Google scholar. Selected keywords included inspiratory/ respiratory muscle training, weaning/failure, mechanical ventilation, critically ill, threshold load, intubated/ tracheostomy. RESULTS: In our analysis we included three randomized control trials involving 150 patients. The studies used different devices of training and training protocols. Inspiratory muscle training significantly increased inspiratory muscle strength in relation to sham or no training. CONCLUSION: Although IMT leads to significant increase of respiratory muscle strength, it has not yet been clearly demonstrated that this also leads to successful weaning. Further larger randomized studies are needed to determine the beneficial effect of IMT in weaning patients from ventilatory support.
Inspiratory Muscle Training in the Intensive Care Unit: A New Perspective
Journal of clinical medicine research, 2017
Prolonged use of mechanical ventilation (MV) leads to weakening of the respiratory muscles, especially in patients subjected to sedation, but this effect seems to be preventable or more quickly reversible using respiratory muscle training. The aims of the study were to assess variations in respiratory and hemodinamic parameters with electronic inspiratory muscle training (EIMT) in tracheostomized patients requiring MV and to compare these variations with those in a group of patients subjected to an intermittent nebulization program (INP). This was a pilot, prospective, randomized study of tracheostomized patients requiring MV in one intensive care unit (ICU). Twenty-one patients were randomized: 11 into the INP group and 10 into the EIMT group. Two patients were excluded in experimental group because of hemodynamic instability. In the EIMT group, maximal inspiratory pressure (MIP) after training was significantly higher than that before (P = 0.017), there were no hemodynamic changes...
Iranian Rehabilitation Journal , 2023
Objectives: This review aimed to explore inspiratory muscle training (IMT) use in patients with mechanical ventilation (MV). The topics were related to its effect on the duration of MV or weaning, respiratory symptoms or lung function, inspiratory muscle strength (IMS) or endurance, functional ability, and quality of life (QoL). Methods: Articles published in the last ten years were reviewed narratively to obtain data about how inspiratory muscle training (IMT) can affect breathing muscle strength in prolonged mechanically ventilated patients. Results: Eleven articles were relevant to the topic, including seven original articles and four systematic reviews. We also found one practical guide on IMT in intensive care unit (ICU) patients. Discussion: Inspiratory muscle weakness is found in most intensive care unit (ICU) patients which further causes difficulty in weaning from MV. No standard protocol exists for the use of IMT in patients who failed to wean from MV. The use of IMT was found to be safe with the incidence of side effects or unexpected events was very rare. Several studies found various effects on the success of weaning after IMT administration, such as decreased MV and weaning duration or no effect on these parameters. Studies also found various effects on IMS or endurance although most investigators found increased IMS after IMT administration. These effects vary with exercise intensity and baseline maximum inspiratory pressure (MIP). The IMT program improves lung function thereby reducing symptoms, leading to improved functional abilities and QoL.improved functional abilities and quality of life (QoL).
Egyptian Journal of Bronchology, 2018
Objective This study aimed to evaluate the effect of inspiratory muscle training (IMT) on weaning time and success. Patients and methods This is a prospective, randomized clinical study conducted in an ICU. A total of 15 patients were trained by inspiratory muscle exercise twice per day and 15 patients did not go under training (control group). Training was conducted through tuning the ventilator sensitivity based on the patients’ maximal inspiratory pressure (MIP). The experimental group received IMT starting with an initial load of 30% of their MIP measured immediately after changing patients to pressure support mode of mechanical ventilation (MV) and increased up to 40% as tolerated by the patient. Training was conducted for 5 min, two sessions per day. In addition, these patients received usual care of MV patients. Sputum culture assessment for aerobic organisms was done immediately after intubation. Results This is a prospective randomized control study that collected data on 3...
BACKGROUND: Inspiratory muscle weakness is a consequence of mechanical ventilation that contributes to weaning failure in critical ill patients. Since 1980, case reports of inspiratory muscle training (IMT) in ventilated, difficult to be weaned patients have proposed that this training strategy is associated with successful weaning. OBJECTIVE: We evaluated the efficacy of the inspiratory muscle training on the weaning process. METHODS: We conducted a literature search in the following databases: PubMed, EMBASE, Scopus and Google scholar. Selected keywords included inspiratory/ respiratory muscle training, weaning/failure, mechanical ventilation, critically ill, threshold load, intubated/ tracheostomy. RESULTS: In our analysis we included three randomized control trials involving 150 patients. The studies used different devices of training and training protocols. Inspiratory muscle training significantly increased inspiratory muscle strength in relation to sham or no training. CONCLUSION: Although IMT leads to significant increase of respiratory muscle strength, it has not yet been clearly demonstrated that this also leads to successful weaning. Further larger randomized studies are needed to determine the beneficial effect of IMT in weaning patients from ventilatory support.
Respiratory dysfunction in ventilated patients: can inspiratory muscle training help?
Anaesthesia and intensive care, 2012
Respiratory muscle dysfunction is associated with prolonged and difficult weaning from mechanical ventilation. This dysfunction in ventilator-dependent patients is multifactorial: there is evidence that inspiratory muscle weakness is partially explained by disuse atrophy secondary to ventilation, and positive end-expiratory pressure can further reduce muscle strength by negatively shifting the length-tension curve of the diaphragm. Polyneuropathy is also likely to contribute to apparent muscle weakness in critically ill patients, and nutritional and pharmaceutical effects may further compound muscle weakness. Moreover, psychological influences, including anxiety, may contribute to difficulty in weaning. There is recent evidence that inspiratory muscle training is safe and feasible in selected ventilator-dependent patients, and that this training can reduce the weaning period and improve overall weaning success rates. Extrapolating from evidence in sports medicine, as well as the kno...