Inspiratory Muscle Training With an Electronic Resistive Loading Device Improves Prolonged Weaning Outcomes in a Randomized Controlled Trial*

Abstract

OBJECTIVES: To test if the use of an inspiratory muscle training program with an electronic resistive loading device is associated with benefits as to muscle strength, weaning, and survival in the ICU. DESIGN: Prospective randomized controlled trial. SETTINGS: Study conducted at the ICU of a Navy’s hospital, Rio de Janeiro, Brazil, from January 2016 to September 2018. PATIENTS: Tracheostomized patients (18–86 yr) on prolonged weaning. INTERVENTIONS: Participants were assigned to inspiratory muscle training (intervention group) or a traditional T-piece protocol (control group). In the inspiratory muscle training group, participants underwent training with an electronic inspiratory training device (POWERbreathe K-5; Technologies Ltd, Birmingham, United Kingdom). MEASUREMENTS AND MAIN RESULTS: Changes in respiratory muscle strength and rates of ICU survival and weaning success were compared between groups. Forty-eight participants in the inspiratory muscle training group and 53 ones in the control group were included in the final analysis. The inspiratory muscle training was associated with a substantially higher gain on muscle strength as assessed by the maximal inspiratory pressure (70.5 [51.0–82.5] vs –48.0 cm H2O [36.0–72.0 cm H2O]; p = 0.003) and the timed inspiratory effort index (1.56 [1.25–2.08] vs 0.99 cm H2O/s [0.65–1.71 cm H2O/s]; p = 0.001). Outcomes at the 60th day of ICU were significantly better in the intervention group regarding both survival (71.1% vs 48.9%; p = 0.030) and weaning success (74.8% vs 44.5%; p = 0.001). CONCLUSIONS: The use of an inspiratory muscle training program with an electronic resistive loading device was associated with substantial muscle strength gain and positive impacts in two very relevant clinical outcomes: the rates of ICU survival and successful weaning.

Randomized Clinical Study of Temporary Transvenous Phrenic Nerve Stimulation in Difficult-to-Wean Patients

“…However, despite improvement in maximal inspiratory pressures, TTDN did not result in improved clinical outcomes. In previous studies, inspiratory muscle training increased both MIP and the proportion of weaned patients compared to control (31). A possible explanation for this difference, compared to our study, is that TTDN might not have yielded sufficient MIP improvement to result in statistically improved clinical outcomes in this under-powered study.…”

“…Several other studies suggest that this is also the case for inspiratory muscle training (14,(29)(30)(31). However, inspiratory muscle training is difficult to generalize because it involves patient cooperation and requires time intensive physiotherapy resources that may not be systematically available.…”

Cardiovascular and Pulmonary Research: The Year (2021) in Review

“…da Silva Guimaraes et al 17 added to this body of literature through the use of a nontraditional threshold device, an electronic loading device. The purpose of this electronic loading was to better match the length tension curve of a muscle.…”

“…17 Each exercise session consisted of 2 bouts of 3 sets of resistance breaths starting at 40% of target load with progression to 100% of target load with each set followed by 2 to 3 minutes of recovery. 17 The results of the study showed that IMST resulted in a higher survival rate and cumulative weaning success compared with the control group at 60 days. 17 In addition, both IMST and duration of ventilation showed significance for contributing to changes in successful weaning from MV.…”

An Update on Cardiorespiratory Physiotherapy during Mechanical Ventilation

“…Daily inspiratory muscle training (IMT) with six to eight contractions repeated in three to four sets at moderate-to-high intensity has been shown to be safe and to improve both inspiratory muscle strength and weaning success in patients with difficulties weaning. 138,139 The studies performed so far on IMT in MV patients have been heterogeneous with regard to inclusion criteria, training modalities and outcomes evaluated. In addition, most of the studies used a mechanical threshold-loading (MTL) IMT device (►Fig.…”