Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial

Cader, Samária Ali; Vale, Rodrigo Gomes Souza; Castro, Juracy Corrêa; Bacelar, Sílvia Correa; Biehl, Cintia; Gomes, M.; Cabrera, Walter; Dantas, Estélio Henrique Martín

doi:10.1016/s1836-9553(10)70022-9

Cited by 99 publications

(138 citation statements)

References 31 publications

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“…Nonetheless, several lines of indirect evidence support the belief that impaired inspiratory muscle function contributes to weaning difficulties. First, although debate exists, several studies reveal that inspiratory muscle endurance is decreased in patients during prolonged MV and that maximal inspiratory pressure generation is lower in patients that experience difficult weaning compared with patients that are successfully weaned (14,15,17,55). Furthermore, a recent study reveals that patients with diaphragmatic contractile dysfunction exhibit a high incidence of weaning failures compared with patients with normal diaphragm function (51).…”

Section: Contribution Of Vidd To Weaning Failurementioning

confidence: 99%

Ventilator-induced diaphragm dysfunction: cause and effect

Powers

Wiggs

Sollanek

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

135

151

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Powers SK, Wiggs MP, Sollanek KJ, Smuder AJ. Ventilator-induced diaphragm dysfunction: cause and effect. Am J Physiol Regul Integr Comp Physiol 305: R464 -R477, 2013. First published July 10, 2013 doi:10.1152/ajpregu.00231.2013 is used clinically to maintain gas exchange in patients that require assistance in maintaining adequate alveolar ventilation. Common indications for MV include respiratory failure, heart failure, drug overdose, and surgery. Although MV can be a life-saving intervention for patients suffering from respiratory failure, prolonged MV can promote diaphragmatic atrophy and contractile dysfunction, which is referred to as ventilator-induced diaphragm dysfunction (VIDD). This is significant because VIDD is thought to contribute to problems in weaning patients from the ventilator. Extended time on the ventilator increases health care costs and greatly increases patient morbidity and mortality. Research reveals that only 18 -24 h of MV is sufficient to develop VIDD in both laboratory animals and humans. Studies using animal models reveal that MV-induced diaphragmatic atrophy occurs due to increased diaphragmatic protein breakdown and decreased protein synthesis. Recent investigations have identified calpain, caspase-3, autophagy, and the ubiquitin-proteasome system as key proteases that participate in MV-induced diaphragmatic proteolysis. The challenge for the future is to define the MV-induced signaling pathways that promote the loss of diaphragm protein and depress diaphragm contractility. Indeed, forthcoming studies that delineate the signaling mechanisms responsible for VIDD will provide the knowledge necessary for the development of a pharmacological approach that can prevent VIDD and reduce the incidence of weaning problems. respiratory muscle; atrophy; mechanical ventilation; weaning; muscle wasting MECHANICAL VENTILATION (MV) is used clinically to achieve sufficient pulmonary gas exchange in patients unable to sustain adequate alveolar ventilation on their own. Common indications for MV include respiratory failure due to chronic obstructive pulmonary disease, status asthmaticus, and/or heart failure. In addition, MV is often an essential intervention in patients suffering from acute drug overdose, neuromuscular diseases, sepsis, and during surgery along with postsurgical recovery.The number of patients receiving prolonged MV in the United States exceeds more than 300,000 each year in the intensive care unit (ICU) (20). Although MV can be a lifesaving measure, prolonged MV results in the rapid development of diaphragmatic weakness due to both atrophy and contractile dysfunction. This detrimental impact of prolonged MV on the diaphragm has been termed ventilator-induced diaphragmatic dysfunction (VIDD) and VIDD is predicted to be a major contributor to problems in weaning patients from the ventilator (26, 114). Although previous reports describing the impact of prolonged MV on the diaphragm have appeared in the literature, advances in our understanding of the mechanisms responsible for VIDD h...

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Section: Contribution Of Vidd To Weaning Failurementioning

confidence: 99%

Ventilator-induced diaphragm dysfunction: cause and effect

Powers

Wiggs

Sollanek

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

135

151

View full text Add to dashboard Cite

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“…This is not in keeping with the report by Plani et al, [11] which showed that physiotherapists' involvement in a weaning and extubation protocol implemented in the management of critically ill trauma patients in an SA ICU setting resulted in a clinically significant reduction in MV time. The use of respiratory muscle trainer devices has been shown to significantly increase maximal inspiratory pressure [12,13] and tidal volume [13] and shorten time to weaning from MV. [12] The majority of respondents reported being involved with extubation of patients and more respondents in the current survey reported involvement with adjustment of mechanical ventilator settings and weaning of patients from MV than reported previously.…”

Section: Resultsmentioning

confidence: 99%

“…The use of respiratory muscle trainer devices has been shown to significantly increase maximal inspiratory pressure [12,13] and tidal volume [13] and shorten time to weaning from MV. [12] The majority of respondents reported being involved with extubation of patients and more respondents in the current survey reported involvement with adjustment of mechanical ventilator settings and weaning of patients from MV than reported previously. [6] However, reasons for continued limited active involvement of physiotherapists in weaning of patients from MV require further exploration.…”

Section: Resultsmentioning

confidence: 99%

Physiotherapy practice in South African intensive care units

Lottering

Aswegen

2016

S Afr J Crit Care

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Background. Physiotherapists are integral members of the interprofessional team that provides care and rehabilitation for patients in intensive care units (ICUs). Objectives. To describe the current practice of physiotherapists in ICUs, determine if physiotherapists' practice has changed since a previous report and determine if practice is evidence based. Methodology. A questionnaire was content validated and made available electronically and in hard copy. Physiotherapists who work in ICUs in public or private sector hospitals or who are members of the South African Society of Physiotherapy were identified and invited to participate. Results. Survey response rate was 33.9%. Patient assessment techniques performed 'very often' included ICU chart assessment (n=90, 83.3%), chest auscultation (n=94, 81.8%) and cough effort (n=81, 75%). Treatment techniques performed 'very often' included manual chest clearance (n=101, 93.5%), in-bed mobilisation and positioning (n=91, 84.3%; n=91, 84.3%, respectively), airway suctioning (n=89, 82.4%), out-of-bed mobilisation (n=84, 77.8%), deep breathing exercises (n=83, 76.9%) and peripheral muscle-strengthening exercises (n=72, 73.1%). More respondents used intermittent positive pressure breathing (57 v. 28%, p=0.00), used adjustment of mechanical ventilation (MV) settings (30 v. 15%, p=0.01), were involved with weaning patients from MV (42 v. 19%, p=0.00) and used incentive spirometry (76 v. 46%, p=0.00) than reported previously. More respondents performed suctioning (99 v. 70%, p=0.00), extubation (60 v. 25%, p=0.00) and adjustment of MV settings (30 v. 12%, p=0.02) than reported internationally. Conclusion. Physiotherapy practice in ICUs is evidence based. Care focuses largely on mobilisation, exercise therapy and multimodality respiratory therapy.

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“…These data suggest that once P 0.1 is reduced, the occurrence of dyspnea decreases (N. Ambrosino et al, 1994;Ferrari et al, 1997). Cader et al(S. A. Cader et al, 2010) investigated elderly patients to detemine whether inspiratory muscle training improved maximal inspiratory pressure, breathing pattern and length of weaning time from mechanical ventilation. Of the 198 patients screened during the recruitment, the 67 eligible individuals were monitored daily to assess readiness to start weaning.…”

Section: Effects Of Inspiratory Muscle Training On the Weaning Procesmentioning

confidence: 99%