Journal
JOURNAL OF PHYSIOTHERAPY
Volume 59, Issue 2, Pages 101-107Publisher
AUSTRALIAN PHYSIOTHERAPY ASSOC
DOI: 10.1016/S1836-9553(13)70162-0
Keywords
Mechanical ventilator weaning; Respiratory muscle training; Ventilator dependent; Ventilator-induced diaphragmatic dysfunction
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Funding
- Fundo de Incentivo a Pesquisa e Eventos (FIPE) - Research and Event Inventive Fund
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Question: Does inspiratory muscle training accelerate weaning from mechanical ventilation? Does it improve respiratory muscle strength, tidal volume, and the rapid shallow breathing index? Design: Randomised trial with concealed allocation and intention-to-treat analysis. Participants: 92 patients receiving pressure support ventilation were included in the study and followed up until extubation, tracheostomy, or death. Intervention: The experimental group received usual care and inspiratory muscle training using a threshold device, with a load of 40% of their maximal inspiratory pressure with a regimen of 5 sets of 10 breaths, twice a day, 7 days a week. The control group received usual care only. Outcome measures: The primary outcome was the duration of the weaning period. The secondary outcomes were the changes in respiratory muscle strength, tidal volume, and the rapid shallow breathing index. Results: Although the weaning period was a mean of 8 hours shorter in the experimental group, this difference was not statistically significant (95% CI -16 to 32). Maximal inspiratory and expiratory pressures increased in the experimental group and decreased in the control group, with significant mean differences of 10 cmH(2)O (95% CI 5 to 15) and 8 cmH(2)O (95% CI 2 to 13), respectively. The tidal volume also increased in the experimental group and decreased in the control group (mean difference 72 ml, 95% CI 17 to 128). The rapid shallow breathing index did not differ significantly between the groups. Conclusion: Inspiratory muscle training did not shorten the weaning period significantly but it increased respiratory muscle strength and tidal volume.
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