Case report: inspiratory muscle training in chronic critically ill patients — A report of two cases

Chang, Angela; Boots, Robert; Henderson, Robert D.; Paratz, Jennifer; Hodges, Paul W.

doi:10.1002/pri.14

Cited by 22 publications

(10 citation statements)

References 19 publications

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“…Chang et al33 observed a post-weaning reduction in the inspiratory muscle strength of patients who had undergone a lengthy period of mechanical ventilation. These results are in agreement with those for the control group, as shown in Table 2.…”

Section: Discussionmentioning

confidence: 99%

Extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training: a randomized clinical trial

Cader¹,

Vale²,

Zamora³

et al. 2012

CIA

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BackgroundThe purpose of this study was to evaluate the extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training (IMT) and identify predictors of successful weaning.MethodsTwenty-eight elderly intubated patients in an intensive care unit were randomly assigned to an experimental group (n = 14) that received conventional physiotherapy plus IMT with a Threshold IMT® device or to a control group (n = 14) that received only conventional physiotherapy. The experimental protocol for muscle training consisted of an initial load of 30% maximum inspiratory pressure, which was increased by 10% daily. The training was administered for 5 minutes, twice daily, 7 days a week, with supplemental oxygen from the beginning of weaning until extubation. Successful extubation was defined by the ventilation time measurement with noninvasive positive pressure. A vacuum manometer was used for measurement of maximum inspiratory pressure, and the patients’ Tobin index values were measured using a ventilometer.ResultsThe maximum inspiratory pressure increased significantly (by 7 cm H2O, 95% confidence interval [CI] 4–10), and the Tobin index decreased significantly (by 16 breaths/ min/L, 95% CI −26 to 6) in the experimental group compared with the control group. The Chi-squared distribution did not indicate a significant difference in weaning success between the groups (χ2 = 1.47; P = 0.20). However, a comparison of noninvasive positive pressure time dependence indicated a significantly lower value for the experimental group (P = 0.0001; 95% CI 13.08–18.06). The receiver-operating characteristic curve showed an area beneath the curve of 0.877 ± 0.06 for the Tobin index and 0.845 ± 0.07 for maximum inspiratory pressure.ConclusionThe IMT intervention significantly increased maximum inspiratory pressure and significantly reduced the Tobin index; both measures are considered to be good extubation indices. IMT was associated with a reduction in noninvasive positive pressure time in the experimental group.

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Section: Discussionmentioning

confidence: 99%

Extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training: a randomized clinical trial

Cader¹,

Vale²,

Zamora³

et al. 2012

CIA

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“…2,6,8 Inspiratory muscle strength training (IMST) has shown promise to counteract inspira-tory muscle weakness. 9,10 A controlled clinical trial from our laboratory demonstrated that IMST increased static maximum inspiratory pressure (P Imax ) and facilitated ventilator weaning in MV-dependent adults. 11 A recent systematic review of IMST also found that higher-intensity training with pressure-threshold devices conferred greater strengthening benefits.…”

Section: Introductionmentioning

confidence: 99%

Effect of Training on Inspiratory Load Compensation in Weaned and Unweaned Mechanically Ventilated ICU Patients

Smith¹,

Gabrielli²,

Davenport

et al. 2013

Respir Care

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BACKGROUND While inspiratory muscle weakness is common in prolonged mechanical ventilation, inspiratory muscle strength training (IMST) can facilitate strengthening and ventilator weaning. However, the inspiratory load compensation (ILC) responses to threshold loads are not well characterized in patients. We retrospectively compared ILC responses according to the clinical outcomes of IMST (ie, maximum inspiratory pressure [PImax], weaning outcome), in difficult-to-wean ICU patients. METHODS Sixteen tracheostomized subjects (10 weaned, 6 unweaned) from a previous clinical trial underwent IMST 5 days/week, at the highest tolerated load, in conjunction with daily, progressive spontaneous breathing trials. PImax and ILC with a 10 cm H2O load were compared in the subjects before and after IMST. Changes in ILC performance were further characterized (5, 10, 15 cm H2O loads) in the trained subjects who weaned. RESULTS Demographics, respiratory mechanics, and initial PImax (52 ± 26 cm H2O vs 42 ± 13 cm H2O) did not significantly differ between the groups. Upon enrollment, PImax significantly correlated with flow ILC responses with the 10 cm H2O load (r = 0.64, P = .008). After IMST, PImax significantly increased in the entire sample (P = .03). Both before and after IMST, subjects who weaned generated greater flow and volume ILC than subjects who failed to wean. Additionally, ILC flow, tidal volume, and duty cycle increased upon ventilator weaning, at loads of 5, 10, and 15 cm H2O. CONCLUSIONS Flow ILC at a threshold load of 10 cm H2O in ventilated, tracheostomized subjects positively correlated with PImax. Although PImax improved in both groups, the flow and volume ILC responses of the weaned subjects were more robust, both before and after IMST. The results suggest that ILC response is different in weaned and unweaned subjects, reflecting dynamic inspiratory muscular efforts that could be influential in weaning.

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“…In healthy people and in people with chronic obstructive pulmonary disease, IMT increases respiratory muscle strength and endurance [19-22]. The effectiveness of IMT in increasing inspiratory muscle strength and endurance in ventilated patients (to potentially reduce weaning duration) has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

Inspiratory muscle training to facilitate weaning from mechanical ventilation: protocol for a systematic review

et al. 2011

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BackgroundIn intensive care, weaning is the term used for the process of withdrawal of mechanical ventilation to enable spontaneous breathing to be re-established. Inspiratory muscle weakness and deconditioning are common in patients receiving mechanical ventilation, especially that of prolonged duration. Inspiratory muscle training could limit or reverse these unhelpful sequelae and facilitate more rapid and successful weaning.MethodsThis review will involve systematic searching of five electronic databases to allow the identification of randomised trials of inspiratory muscle training in intubated and ventilated patients. From these trials, we will extract available data for a list of pre-defined outcomes, including maximal inspiratory pressure, the duration of the weaning period, and hospital length of stay. We will also meta-analyse comparable results where possible, and report a summary of the available pool of evidence.DiscussionThe data generated by this review will be the most comprehensive answer available to the question of whether inspiratory muscle training is clinically useful in intensive care. As well as informing clinicians in the intensive care setting, it will also inform healthcare managers deciding whether health professionals with skills in respiratory therapy should be made available to provide this sort of intervention. Through the publication of this protocol, readers will ultimately be able to assess whether the review was conducted according to a pre-defined plan. Researchers will be aware that the review is underway, thereby avoid duplication, and be able to use it as a basis for planning similar reviews.

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Case report: inspiratory muscle training in chronic critically ill patients — A report of two cases

Cited by 22 publications

References 19 publications

Extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training: a randomized clinical trial

Extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training: a randomized clinical trial

Effect of Training on Inspiratory Load Compensation in Weaned and Unweaned Mechanically Ventilated ICU Patients

Inspiratory muscle training to facilitate weaning from mechanical ventilation: protocol for a systematic review

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