Use of Inspiratory Muscle Strength Training to Facilitate Ventilator Weaning.

Case report: inspiratory muscle training in chronic critically ill patients — A report of two cases

“…The load was progressively increased, with rests in between, until the subject reported a Borg score between 6 and 8 on the scale, and recorded this as MIP load . These values for MIP load are similar to those reported by previous authors for chronic critically ill patients who have difficulty weaning from mechanical ventilation (Martin et al, 2002;Sprague and Hopkins, 2003).…”

“…The IMT programme outlined in the Case Report was designed to provide an adequate training stimulus to induce neuromuscular changes, without the development of inspiratory muscle pump failure. This was achieved by providing rest periods during the training programme, and by monitoring the patient's perceived exertion, in a manner similar to previous studies in long-term intensive care patients (Martin et al, 2002;Sprague and Hopkins, 2003). The improvements in MIP and MIP load may reflect a training effect and were similar in magnitude to those found in studies of IMT in patients with chronic obstructive pulmonary disease (Preusser et al, 1994;Larson et al, 1999).…”

“…Inspiratory muscle strength was measured by maximal inspiratory pressure (MIP) at residual volume (ATS, 2002a). A marker of inspiratory muscle endurance was measured using a method outlined by Martin et al (2002), in which subjects inspired though an inspiratory threshold trainer (Threshold TM , Mayo Healthcare) for six to eight breaths and the perceived exertion was recorded on a 10point scale. The load was progressively increased, with rests in between, until the subject reported a Borg score between 6 and 8 on the scale, and recorded this as MIP load .…”

“…Often called 'chronic critically ill patients', these individuals have been 222 Physiotherapy Research International 10(4) 222-226 (2005) DOI: 10.1002/pri.14 shown to make up only 5.8% of intensive care unit (ICU) admissions, but they utilize a greater proportion of resources -up to 54% of total ICU resources in some cases (Stricker et al, 2003). Difficulty in weaning from mechanical ventilation is a common reason for the prolonged ICU admission in this population, and recent studies have proposed the use of inspiratory muscle training (IMT) to facilitate weaning in these patients (Martin et al, 2002;Sprague and Hopkins, 2003). Although preliminary studies have demonstrated successful weaning in the majority of cases (Martin et al, 2002;Sprague and Hopkins, 2003), respiratory muscle weakness may be present at the end of the training programme.…”

“…Difficulty in weaning from mechanical ventilation is a common reason for the prolonged ICU admission in this population, and recent studies have proposed the use of inspiratory muscle training (IMT) to facilitate weaning in these patients (Martin et al, 2002;Sprague and Hopkins, 2003). Although preliminary studies have demonstrated successful weaning in the majority of cases (Martin et al, 2002;Sprague and Hopkins, 2003), respiratory muscle weakness may be present at the end of the training programme.…”