Use of Inspiratory Muscle Strength Training to Facilitate Ventilator Weaning

Martin, A. Daniel; Davenport, Paul; Franceschi, Amy; Harman, Eloise

doi:10.1378/chest.122.1.192

Cited by 92 publications

(36 citation statements)

References 18 publications

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“…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). Finally, a growing number of studies suggest that inspiratory muscle training, designed to increase diaphragm strength and endurance, increases weaning success in patients who previously failed repeated weaning attempts by conventional methods (3,65,66,104). Collectively, these studies support the concept that VIDD contributes to weaning failure and therefore the prevention of VIDD is a potential therapeutic target to prevent weaning difficulties.…”

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

139

156

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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

139

156

View full text Add to dashboard Cite

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“…Although IMT of patients under MV is of short duration, some studies report that muscle strength gain is due to neural adaptation (A. D. Martin, et al, 2002;Sprague & Hopkins, 2003) rather than muscle hypertrophy. The following mechanisms emerge as a result of this adaptation: increased maximum voluntary contraction ability; decreased antagonist muscle coactivation; greater motor unit synchrony or a more efficient motor program (Carolan & Cafarelli, 1992;McComas, 1994;Milner-Brown, et al, 1975;Sale, 1988;Yue & Cole, 1992).…”

Section: Respiratory Muscle Trainingmentioning

confidence: 99%

“…Capdevila et al, 1998;Cluzel et al, 2000;A. D. Martin et al, 2002;, which leads to prolonged dependence on MV (Vassilakopoulos & Petrof, 2004).…”

mentioning

confidence: 99%

Effect of Inspiratory Muscle Training on Weaning Success in Critically Ill Intubated Patients

Cader¹,

Vale²,

Dantas³

2012

Physical Therapy Perspectives in the 21st Century - Challenges and Possibilities

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“…Pressure resistive inspiratory training devices showed improvements in different parameters with several cases such as; Asthma [8], chronic obstructive pulmonary disease (COPD), Cystic Fibrosis [16], Hypertensive [17] and ventilator dependent patients [18]. Since COPD patients have daily limitations triggered by respiratory muscle fatigue, many authors have established their studies on them.…”

Section: Introductionmentioning

confidence: 99%

A Comparison between Two Types of Resistive Inspiratory Muscle Training Devices in Normal Subjects in Regards to Pulmonary Functions

Alwohayeb¹,

Alenazi²,

Albuainain³

et al. 2018

Int J Phys Med Rehabil

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Introduction: Inspiratory muscle training (IMT) devices improve respiratory muscle strength, endurance and exercise capacity on healthy subjects. Because of the limited availability of the effect of IMT devices on healthy subjects with minimal activity level, this study was conducted to evaluate the effects of POWERbreath-plus® and Threshold IMT® on healthy subjects by measuring pre and post Maximal inspiratory pressure (MIP), Maximal expiratory pressure (MEP), Peak Expiratory Flow Rate (PEFR) and Mandatory Voluntary Ventilation (MVV) and to compare their effectiveness.

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Use of Inspiratory Muscle Strength Training to Facilitate Ventilator Weaning

Cited by 92 publications

References 18 publications

Ventilator-induced diaphragm dysfunction: cause and effect

Ventilator-induced diaphragm dysfunction: cause and effect

Effect of Inspiratory Muscle Training on Weaning Success in Critically Ill Intubated Patients

A Comparison between Two Types of Resistive Inspiratory Muscle Training Devices in Normal Subjects in Regards to Pulmonary Functions

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