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

Abstract

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.

Inspiratory Muscle Training in the Intensive Care Unit: A New Perspective

“…Selection of the study population was made easy owing to the large number of patients needing a tracheostomy tube because of difficulties with weaning. This is in accordance with the study by Cader et al [ 17 ], which treated intubated patients using a respiratory muscle training protocol, with a view to increasing the extubation success rate; however, of the 198 patients selected for their study, only 28 were randomized, as the majority of the population was subject to tracheostomy tube or died.…”

Increased SOD2 in the diaphragm contributes to exercise-induced protection against ventilator-induced diaphragm dysfunction

“…Unfortunately, an unintended consequence of prolonged MV is the rapid development of diaphragmatic atrophy and contractile dysfunction which is collectively termed ventilator-induced diaphragm dysfunction (VIDD) [3] , [16] , [30] , [31] . VIDD is predicted to be a major contributor to difficulties in weaning patients from the ventilator [7] , [30] . Indeed, as many as one third of MV patients that are exposed to ≥ 48 h of ventilator support experience difficult weaning [5] , [6] , [30] .…”

Effects of different types and frequencies of early rehabilitation on ventilator weaning among patients in intensive care units: A systematic review and meta-analysis

“…Regarding multiple-component treatments as early rehabilitation intervention, 83% (10/12) of studies did not show significant benefit either in the outcomes related to ventilator weaning, when compared to the low dosage of intervention, medical treatment, or usual care as the control group [ 38 – 48 ]. Three studies using CPT, which were primarily comprised of chest physical therapy and range of motion exercise, did not show significant improvement in weaning outcomes [ 49 – 51 ]. All four studies using NMES alone or combined exercises as an intervention did not show significant benefit on ventilator weaning [ 41 , 42 , 52 , 53 ].…”

“…On the other hand, most EPTs in our included studies were limb-strengthening exercises and had limited benefit on ventilator weaning. By contrast, inspiratory muscle strengthening may be a choice when the ICU team focused on the respiratory system [ 49 ].…”