Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review

Abstract

Inspiratory muscle training for selected patients in the intensive care unit facilitates weaning, with potential reductions in length of stay and the duration of non-invasive ventilatory support after extubation. The heterogeneity among the results suggests that the effects of inspiratory muscle training may vary; this perhaps depends on factors such as the components of usual care or the patient's characteristics.

Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications

“…Taken together, these results provide evidence that TFdi can be used as a reliable estimator of diaphragm function in this setting. Beyond prognostic purposes, this could prove useful for the management of indications and the follow-up of putative therapeutic approaches such as inspiratory muscle training39 or diaphragm pacing 11 40…”

Recovery from ICU-acquired weakness; do not forget the respiratory muscles!

“…The higher mortality in the IMT group is in contrast with the findings reported in a recent meta-analysis on the effects of IMT to facilitate liberation from mechanical ventilation. The authors reported a slightly higher, but not statistically significant, likelihood of survival in the IMT group when pooling data from four studies (n=242; relative risk (95% CI) of survival: 1.04 (0.96 to 1.13)) 17. Weighted mortality rates were 6.4% in the intervention group and 10.3% in the control group.…”

“…Surprisingly, little attention has been given to specific interventions to enhance strength and endurance of the respiratory muscles. Indeed, daily intermittent inspiratory loading with six to eight contractions repeated in three to four series at moderate to high intensity was safe, improved inspiratory muscle strength and weaning success in patients with difficult weaning 17. One of the challenges of these studies is that patients who might benefit from the intervention are oftentimes not sufficiently able to participate in the training sessions.…”

Inspiratory muscle training to enhance recovery from invasive mechanical ventilation

“…Since 2011, 9 randomised trials of inspiratory muscle training in intensive care patients have been published (Cader et al, 2010, Martin et al, 2011, Condessa et al, 2013, Dixit and Prakash, 2014, Elbouhy et al, 2014, Ibrahiem et al, 2014, Pascotini et al, 2014, Shimizu et al, 2014, and the results of these studies have been summarised in 2 systematic reviews with meta-analyses (Moodie et al, 2011, Elkins andDentice, 2015). While the metaanalyses confirmed that inspiratory muscle training in ventilator-dependent patients increases respiratory muscle strength and facilitates weaning (Moodie et al, 2011, Elkins andDentice, 2015), there is wide variability in both patient selection and training programs used across the studies. For example, Cader et al (2010) studied inspiratory muscle training in patients aged over 70 but excluded those with tracheostomies.…”

“…After 18 to 69 hours of controlled mechanical ventilation, diaphragm proteolysis and atrophy occurs (Levine et al, 2008) and respiratory muscle weakness has been observed both while patients are mechanically ventilated (De Jonghe et al, 2007) and following successful extubation (Chang et al, 2005a, Bissett et al, 2015b. Persistent respiratory muscle weakness may contribute to the residual dyspnoea (Bissett et al, 2015b), impaired physical function , Bissett et al, 2015b) and poor quality of life (Cuthbertson et al, 2010) (Bissett and Leditschke, 2007, Cader et al, 2010, Martin et al, 2002, Martin et al, 2011, Condessa et al, 2013) and a recent systematic review suggested that IMT performed prior to extubation enhances weaning success, although it does not appear to reduce rates of reintubation or likelihood of survival (Elkins and Dentice, 2015).…”