Inspiratory Muscle Training in a Newborn With Anoxia Who Was Chronically Ventilated

Abstract

<jats:sec><jats:title>Background and Purpose</jats:title><jats:p>Respiratory muscle training promotes weaning in patients who are dependent on mechanical ventilation. Respiratory muscles can be trained using linear inspiratory-resistive loads to improve their strength and endurance. The purpose of this case report is to demonstrate that a therapeutic intervention consisting of a linear pressure load device facilitates ventilator weaning in an infant who is chronically ventilated.</jats:p></jats:sec><jats:sec><jats:title>Case Description</jats:title><jats:p>The patient was a newborn with a weight of 4,725 g and an Apgar score of 0 to 1 who had been on mechanical ventilation for 8 months. Respiratory muscle training with a linear pressure load was performed twice a day. The number of series and repetitions was increased progressively while maintaining the pressure load, with 3-minute intervals between series, until reaching a peak of 8 series with 70 repetitions and a pressure load of 13 cm H2O. During the intervention, the patient was maintained in the supine position at an elevation of 30 degrees.</jats:p></jats:sec><jats:sec><jats:title>Outcomes</jats:title><jats:p>The infant required mechanical ventilation for 8 months (32 weeks of life), with 4,450 hours (26.5 weeks) of mechanical ventilation and 230 cumulative hours (1.4 weeks) of spontaneous breathing, without obtaining any weaning success. At 10 months of age (40 weeks) and after 2 months (8 weeks) of respiratory muscle training, the results were 490 hours (3 weeks) of mechanical ventilation and 854 hours (5 weeks) of spontaneous breathing. Complete independence of the infant from mechanical ventilation was achieved thereafter.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>This case report describes respiratory muscle training using a linear pressure load device to successfully wean an infant from mechanical ventilation. However, well-controlled clinical trials are necessary to better understand the effects of this intervention on neonatal respiratory muscles.</jats:p></jats:sec>

Inspiratory Muscle Training in Children: Moderate Loads (60%) Are Safe and Promote an Increase in PIMAX

“…A normal or almost normal rate of PIMAX is useful to rule out weakness of the respiratory muscles and obviates the need for complex and/or invasive testing. (25)(26)(27)(28) So far, few pediatric studies have evaluated the effect of inspiratory muscle training on muscle strength and on clinical outcomes, such as the duration of ventilatory assistance (12)(13)(14) , limiting themselves to the description of clinical cases. When considering a protocol for inspiratory muscle training, it was unclear whether moderate load training could cause muscle fatigue since the diaphragm contracts 24 hours/day without a break.…”

“…(11,12) There is still a scarcity of literature on pediatric population, and most of it consists of descriptions of isolated case reports evaluating low-load muscle training in patients with di cult ventilator weaning. (13)(14) Methods This study aims at assessing whether moderate-load muscular training increases the inspiratory muscle strength, which was evaluated by measurements of maximal inspiratory pressure (PIMAX) in patients dependent on mechanical ventilation. This is a retrospective study conducted using analysis of medical records data from patients who met the inclusion criteria determining for the design of the sample.…”

Effect of Inspiratory Muscle Training in Children with Prolonged Invasive Mechanical Ventilation: Report of Six Cases

“…There is still a scarcity of literature on pediatric population, and most of it consists of descriptions of isolated case reports evaluating low-load muscle training in patients with difficult ventilator weaning [13,14].…”

Efficacy of Inspiratory Training on Blood Gases and Brain Naturitic Peptide Among Patients With Heart Failure

“…Other benefits such as improving the endothelial function, blunting catecholamine spillover, increasing peripheral oxygen extraction, and reducing hospital admission. 9 Inspiratory muscle trainer (IMT) with adequate loads improves the strength of the inspiratory muscle. This improvement in the mechanical efficiency of respiratory muscles obtained through out the adequate program of a specific training.…”

“…Various reports suggest that the capacity of respiratory muscles can increase through appropriate stimuli that augment the load impose on them and, thus the training of respiratory muscles aims to facilitate these types of cellular changes in the muscle activated. 9,10 Selective IMT is effective with patients with chronic heart failure mechanisms underlying these beneficial effects of IMT included attenuated during metaboreflex, improved ventilatory efficiency, and lower ventilatory oscillations during incremental exercise. It is proposed that the metabolic products accumulated from fatiguing respiratory muscle contraction could increase sympathetic vasoconstriction activity (the inspiratory muscle metaboreflex), and the attenuation of the metaboreflex could then improve blood flow redistribution to skeletal muscles in the body, thereby delaying the time to fatigue and decreasing work load on the heart.…”