Weaning from mechanical ventilation in people with neuromuscular disease: a systematic review

Neto, Saint Clair Gomes Bernardes; Torres‐Castro, Rodrigo; Lima, Íllia Nadinne Dantas Florentino; Resqueti, Vanessa; Fregonezi, Guilherme A. F.

doi:10.1136/bmjopen-2020-047449

Cited by 13 publications

(15 citation statements)

References 30 publications

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“… 2 10 Note that early tracheostomy during weaning from mechanical ventilation in critical care has not been shown to improve mortality or length of critical care admission. 52 55 …”

Section: Resultsmentioning

confidence: 99%

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Development of respiratory care guidelines for Duchenne muscular dystrophy in the UK: key recommendations for clinical practice

Childs,

Turner,

Astin

et al. 2023

Thorax

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Significant inconsistencies in respiratory care provision for Duchenne muscular dystrophy (DMD) are reported across different specialist neuromuscular centres in the UK. The absence of robust clinical evidence and expert consensus is a barrier to the implementation of care recommendations in public healthcare systems as is the need to increase awareness of key aspects of care for those living with DMD. Here, we provide evidenced-based and/or consensus-based best practice for the respiratory care of children and adults living with DMD in the UK, both as part of routine care and in an emergency.MethodologyInitiated by an expert working group of UK-based respiratory physicians (including British Thoracic Society (BTS) representatives), neuromuscular clinicians, physiotherapist and patient representatives, draft guidelines were created based on published evidence, current practice and expert opinion. After wider consultation with UK respiratory teams and neuromuscular services, consensus was achieved on these best practice recommendations for respiratory care in DMD.ResultThe resulting recommendations are presented in the form of a flow chart for assessment and monitoring, with additional guidance and a separate chart setting out key considerations for emergency management. The recommendations have been endorsed by the BTS.ConclusionsThese guidelines provide practical, reasoned recommendations for all those managing day-to-day and acute respiratory care in children and adults with DMD. The hope is that this will support patients and healthcare professionals in accessing high standards of care across the UK.

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“… 2 10 Note that early tracheostomy during weaning from mechanical ventilation in critical care has not been shown to improve mortality or length of critical care admission. 52 55 …”

Section: Resultsmentioning

confidence: 99%

“…NIV and MI-E use following extubation is strongly recommended. [52][53][54] The use of tracheostomy in acute illness should be discussed with a respiratory team with experience in the management of DMD. Tracheostomy formation should only be undertaken following advice from a specialist centre.…”

Section: Emergency Care Considerationsmentioning

confidence: 99%

Development of respiratory care guidelines for Duchenne muscular dystrophy in the UK: key recommendations for clinical practice

Childs,

Turner,

Astin

et al. 2023

Thorax

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“…Some researchers conducted a systematic review to explore effective ventilator weaning strategies for patients with neuromuscular diseases. However, they did not nd a relevant randomized controlled study and called for more high-quality trials 10 . Therefore, there is a lack of clinical research on the application of IMT to patients with neuromuscular diseases.…”

Section: Background and Rationalementioning

confidence: 99%

Effectiveness of inspiratory muscle training in difficult to wean patients with neuromuscular diseases: A protocol for a randomized controlled trial

Qiu,

Chen,

et al. 2024

Preprint

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Background: Respiratory failure is the main reason for patients with neuromuscular diseases (NMDs) admitted to the intensive care unit (ICU) for mechanical ventilation. Most of these patients have prolonged ventilation time and difficulty in weaning, resulting in prolonged ICU stay and increased medical costs. Inspiratory muscle training, a treatment method for weaning, has been proven by studies to assist weaning, but few studies have included patients with neuromuscular disease. The aims of this study is to investigate whether inspiratory muscle training can help patients with NMDs who have difficulty weaning from ventilators, and to compare the efficacy of inspiratory muscle strength training and endurance training methods in patients with NMDs. Methods: This is a 4-week, double-blind, prospective randomized controlled study. 150 patients will be recruited and randomly assigned to either inspiratory muscle strength training (IMST) group or inspiratory muscle endurance training (IMET) group, in a 1:1 ratio. Patients, investigators, and outcome assessors are unaware of treatment allocation. The IMST group receives high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure, MIP) once per day, five days per week for four weeks. The IMET group receives low-intensity training (2 sets of 30 breaths at 30% of MIP) once per day, five days per week for four weeks. The primary outcome measure is the weaning success difference between the IMST group and IMET groups. The Secondary outcomes are the duration of weaning process, length of stay in the ICU, duration of mechanical ventilation, MIP, diaphragm mobility, diaphragm thickness, diaphragm thickening fraction and Rapid Shallow Breathing Index. Discussion: The results of the study will provide evidence-based basis for weaning training treatment for patients with neuromuscular diseases and will identify the optimum IMT method for such patients. Trial registration: The study was registered on Chinese Clinical Trial Registry: ChiCTR2300071173 on May 6,2023, https://www.chictr.org.cn/bin/project/edit?pid=195557.

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“…Nevertheless, extrapolating these findings support more broadly a physiologic-based approach to PEEP titration and weaning. Patients with neuromuscular disease are at increased risk of weaning failure and requiring tracheotomy, yet there is a paucity of literature specifically addressing weaning protocols, let alone PEEP weaning protocols, in these patients [28]. Although robust prospective studies would be necessary, for now, we can infer that a similar physiologic-based approach to PEEP weaning could be helpful in these patients or in other difficult-to-wean patients, such as those with cardiac dysfunction.…”

Section: Key Pointsmentioning

confidence: 99%

Optimal positive-end expiratory pressure weaning in acute respiratory distress syndrome patients

McNamara,

Baedorf Kassis

2023

Current Opinion in Critical Care

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Purpose of review Positive-end expiratory pressure (PEEP) is a tool in managing acute respiratory distress syndrome (ARDS). In this review, we discuss the various approaches to weaning PEEP after the acute phase of ARDS. Recent findings There is a paucity of research specifically looking at the differences between PEEP weaning protocols. Data in some populations though, particularly those with elevated BMI, suggest that a physiologic approach to PEEP weaning may be helpful. Use of various tools to optimize PEEP prior to and during spontaneous breathing trials (SBTs) may allow for improved alveolar recruitment and respiratory outcomes. Summary Although further prospective studies are warranted, we should consider using a physiologic approach to PEEP weaning in ARDS rather than a one size fits all model, which is currently the standard used in many clinical trials and throughout many ICUs.

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Weaning from mechanical ventilation in people with neuromuscular disease: a systematic review

Cited by 13 publications

References 30 publications

Development of respiratory care guidelines for Duchenne muscular dystrophy in the UK: key recommendations for clinical practice

Development of respiratory care guidelines for Duchenne muscular dystrophy in the UK: key recommendations for clinical practice

Effectiveness of inspiratory muscle training in difficult to wean patients with neuromuscular diseases: A protocol for a randomized controlled trial

Optimal positive-end expiratory pressure weaning in acute respiratory distress syndrome patients

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