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

Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical Ventilation: A Targeted Approach

“…From a patient perspective, respiratory muscle weakness typically renders patients breathless at rest, let alone during exercise [7]. Yet while ICU physiotherapists now invest considerable energy in providing early mobilization therapy to offset the impact of ICUacquired weakness [11,12], the respiratory muscles are frequently neglected in the rehabilitation approach [13]. Clearly respiratory muscle atrophy is an important aspect of ICU-acquired weakness, and we can no longer afford to ignore respiratory muscle rehabilitation as part of holistic recovery for ICU survivors.…”

“…Indeed, the expiratory muscles have been described as the "neglected component" of the respiratory system in a recent comprehensive review that describes expiratory muscle physiology in ICU patients [25]. In the most recent systematic review of respiratory muscle training in ICU patients [22], four studies of expiratory muscle training (comprising 153 participants) were metaanalyzed, revealing a mean difference of 9 cmH 2 O (95% CI [5][6][7][8][9][10][11][12][13][14] in favor of the training group relative to control. However, the effect of expiratory muscle training on patient outcomes requires further exploration in an ICU context.…”

Weaning failure and respiratory muscle function: What has been done and what can be improved?

“…Furthermore, IMT following successful extubation might also be warranted [84]. Bissett et al [74] addressed this question in a randomized trial with 70 participants following 48 h of successful weaning to receive IMT in addition to usual care.…”

“…Additionally, improvement in quality of life was greater in the training group (14% vs 2%, mean difference 12%, p = 0.03). Gosselink and Langer [84] highlighted some reasons that could have been involved in the lack of transfer effects to exercise performance and dyspnoea: 1) Duration of training program, 2 weeks of training may be too short to improve exercise performance and dyspnoea; 2) To obtain these effects, a rehabilitation programme combining limb muscle training and respiratory muscle training is probably warranted; 3) the progress of training intensity during the 2 weeks may not adjusted properly.…”

Can inspiratory muscle training improve weaning outcomes in difficult to wean patients? A protocol for a randomised controlled trial (IMweanT study)

“…Intermittent spontaneous breathing periods (eg, using partially assisted modes of ventilation or spontaneous modes) are frequently applied during mechanical ventilation and may protect the respiratory muscles from the deleterious effects of prolonged inactivity. 11 12 Limited data are also available showing that specific resistance training of the inspiratory muscles (IMT) can improve both respiratory muscle function and weaning outcomes. 13–15 Available data indicate that the intervention is feasible and safe to apply in mechanically ventilated patients.…”