Inspiratory muscle training in mechanical ventilation: suitable protocols and endpoints, the key to clear results - a critical review
Treinamento muscular inspiratório em ventilação mecânica: protocolos e parâmetros adequados, a chave para resultados claros- uma revisão crítica
Paulo Eugênio Silva
Abstract
Definitely, mechanical ventilation (MV) is a life-saving treatment in the intensive care unit (ICU), but it is also a double-edged sword. Forty percent of the overall time spent in the ICU was reported to be devoted to weaning of MV. The major cause of weaning failure is the imbalance between the imposed load on the respiratory system and its capacity to overcome that. Thus, since the 1980’s numerous studies with inspiratory muscle training (IMT) have been conducted in an attempt to reduce weaning and MV time in prolonged mechanically ventilated patients. Despite dozens of published research, only 5 randomized controlled trials (RCT) were conducted until this date. Nevertheless, it was not yet clear whether IMT led to a shorter duration of mechanical ventilation, improved weaning success, or improved survival. These RCT show considerable heterogeneity among them and possible bias that could have impaired their results. Thus, some questions may be made to highlight main points: What is the ideal prescription of IMT for patients on MV? What is the best time to measure treatment effect? Which kind of device should be used to IMT? What are the best endpoints to evaluate the effects of IMT on the process of discontinuing from MV? IMT on mechanically ventilated patients seems to be a promissory treatment despite controversial results. Therefore, RCTs should be carried out to verify the efficacy of new protocols in different approaches.
Keywords
References
1. Wunsch H, Linde-Zwirble WT, Angus DC, Hartman ME, Milbrandt EB, Kahn JM. The epidemiology of mechanical ventilation use in the United States. Crit Care Med. 2010 Oct;38(10):1947–53.
2. Zilberberg MD, de Wit M, Shorr AF. Accuracy of previous estimates for adult prolonged acute mechanical ventilation volume in 2020: update using 2000-2008 data. Crit Care Med. 2012 Jan;40(1):18–20.
3. Ambrosino N. Weaning and respiratory muscle dysfunction: the egg-chicken dilemma. Chest. 2005 Aug;128(2):481–3.
4. Vassilakopoulos T, Petrof BJ. Ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med. 2004 Feb 1;169(3):336–41.
5. Aldrich TK, Karpel JP. Inspiratory muscle resistive training in respiratory failure. Am Rev Respir Dis. 1985 Mar;131(3):461–2.
6. Sprague SS, Hopkins PD. Use of inspiratory strength training to wean six patients who were ventilator- dependent. Phys Ther. 2003 Feb;83(2):171–81.
7. Martin AD, Davenport PD, Franceschi AC, Harman E. Use of inspiratory muscle strength training to facilitate ventilator weaning: a series of 10 consecutive patients. Chest. 2002 Jul;122(1):192–6.
8. Moodie L, Reeve J, Elkins M. Inspiratory muscle training increases inspiratory muscle strength in patients weaning from mechanical ventilation: a systematic review. J Physiother. 2011 Jan;57(4):213–21.
9. MacIntyre NR. Respiratory mechanics in the patient who is weaning from the ventilator. Respir Care. 2005 Feb;50(2):275–86.
10. Ambrosino N, Gabbrielli L. The difficult-to-wean patient. Expert Rev Respir Med. 2010 Oct;4(5):685–92.
11. Hudson MB, Smuder AJ, Nelson WB, Bruells CS, Levine S, Powers SK. Both high level pressure support ventilation and controlled mechanical ventilation induce diaphragm dysfunction and atrophy. Crit Care Med. 2012 May;40(4):1254–60.
12. Mrozek S, Jung B, Petrof BJ, Pauly M, Roberge S, Lacampagne A, et al. Rapid Onset of Specific Diaphragm Weakness in a Healthy Murine Model of Ventilator-induced Diaphragmatic Dysfunction. Anesthesiology. 2012 Sep;117(3):560–7.
13. Karakurt Z, Fanfulla F, Ceriana P, Carlucci A, Grassi M, Colombo R, et al. Physiologic determinants of prolonged mechanical ventilation in patients after major surgery. J Crit Care. 2012 Apr;27(2):221.e9–16.
14. Carlucci A, Ceriana P, Prinianakis G, Fanfulla F, Colombo R, Nava S. Determinants of weaning success in patients with prolonged mechanical ventilation. Crit Care. 2009 Jan;13(3):R97.
15. Roussos CS, Macklem PT. Diaphragmatic fatigue in man. J Appl Physiol. 1977 Aug;43(2):189–97.
16. Bellemare F, Grassino A. Effect of pressure and timing of contraction on human diaphragm fatigue. J Appl Physiol. 1982 Nov;53(5):1190–5.
17. Cader SA, Vale RG de S, Castro JC, Bacelar SC, Biehl C, Gomes MCV, et al. Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial. J Physiother. 2010 Jan;56(3):171–7.
18. Martin AD, Smith BK, Davenport PD, Harman E, Gonzalez-Rothi RJ, Baz M, et al. Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Crit Care. 2011 Jan;15(2):R84.
19. Caruso P, Denari SD, Ruiz SA, Bernal KG, Manfrin GM, Friedrich C, et al. Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients. Clinics. 2005; 60(6):479–84.
20. Cader SA, de Souza Vale RG, Zamora VE, Costa CH, Dantas EHM. Extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training: a randomized clinical trial. Clin Interv Aging. 2012 Jan;7:437–43.
21. Condessa RL, Brauner JS, Saul AL, Baptista M, Silva ACT, Vieira SRR. Inspiratory muscle training did not accelerate weaning from mechanical ventilation but did improve tidal volume and maximal respiratory pressures: a randomised trial. J Physiother. 2013 Jun;59(2):101–7.
22. Romer LM, McConnell AK, Jones DA. Effects of inspiratory muscle training on time-trial performance in trained cyclists. J Sport Sci. 2002 Jul;20(7):547–62.
23. Illi SK, Held U, Frank I, Spengler CM. Effect of respiratory muscle training on exercise performance in healthy individuals: a systematic review and meta-analysis. Sport Med. 2012 Aug 1;42(8):707–24.
24. Hill K, Jenkins SC, Philippe DL, Cecins N, Shepherd KL, Green DJ, et al. High-intensity inspiratory muscle training in COPD. Eur Respir J. 2006 Jun;27(6):1119-28.
25. Weiner P, Zeidan F, Zamir D, Pelled B, Waizman J, Beckerman M, et al. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg. 1998 May;22(5):427-31.
26. Koessler W, Wanke T, Winkler G, Nader A, Toifl K, Kurz H, et al. 2 Years’ experience with inspiratory muscle training in patients with neuromuscular disorders. Chest. 2001 Sep;120(3):765-9.
27. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002 Aug 15;166(4):518-624.
28. De Souza LC, da Silva CT, Lugon JR. Evaluation of the inspiratory pressure using a digital vacuometer in mechanically ventilated patients: analysis of the time to achieve the inspiratory peak. Respir Care. 2012 Feb;57(2):257-62.
29. Tobin MJ, Jubran A. Variable performance of weaning-predictor tests: role of Bayes’ theorem and spectrum and test-referral bias. Intensive Care Med. 2006 Dec;32(12):2002-12.
30. Boles J-M, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007 May;29(5):1033-56.
31. McConville JF, Kress JP. Weaning Patients from the Ventilator. N Engl J Med. 2012 Dec 6;367(23):2233-9.
32. Bissett BM, Leditschke IA, Paratz JD, Boots RJ. Protocol: inspiratory muscle training for promoting recovery and outcomes in ventilated patients (IMPROVe): a randomised controlled trial. BMJ Open. 2012 Jan;2(2):e000813.
33. Caine MP, McConnell AK. The inspiratory muscles can be trained differentially to increase strength or endurance using a pressure threshold, inspiratory muscle training device. Eur Respir Soc. 1998;12:58-9. Abstract.
34. Polla B, D’Antona G, Bottinelli R, Reggiani C. Respiratory muscle fibres: specialisation and plasticity. Thorax. 2004 Sep;59(9):808-17.
35. Gosselink R, Decramer M. Inspiratory muscle training: where are we? Eur Respir J. 1994 Dec;7(12):2103-5.
36. Citterio G, Sironi S, Piccoli S, Agostoni E. Slow to fast shift in inspiratory muscle fibers during heat tachypnea. Respir Physiol. 1983 Feb;51(2):259-74.
37. Volianitis S, McConnell A, Jones D. Assessment of maximum inspiratory pressure. Prior submaximal respiratory muscle activity (’warm-up’) enhances maximum inspiratory activity and attenuates the learning effect of repeated measurement. Respiration. 2001;68(1):22-7.
38. Marini JJ, Smith TC, Lamb V. Estimation of inspiratory muscle strength in mechanically. J Crit Care. 1986;1(1):32-8.
39. Jones DA, Rutherford OM, Parker DF. Physiological changes in skeletal muscle as a result of strength training. Q J Exp Physiol. 1989 May;74(3):233-56.
40. Seynnes OR, de Boer M, Narici M V. Early skeletal muscle hypertrophy and architectural changes in response to high-intensity resistance training. J Appl Physiol. 2007 Jan;102(1):368-73.
41. Romer LM, McConnell AK. Specificity and reversibility of inspiratory muscle training. Med Sci Sport Exerc. 2003 Feb;35(2):237-44.
42. Downey AE, Chenoweth LM, Townsend DK, Ranum JD, Ferguson CS, Harms CA. Effects of inspiratory muscle training on exercise responses in normoxia and hypoxia. Respir Physiol Neurobiol. 2007 May 14;156(2):137-46.
43. Langer D, Jacome C, Charususin N, Scheers H, McConnell A, Decramer M, et al. Measurement jvalidity of an electronic inspiratory loading device during a loaded breathing task in patients with COPD. Respir Med. 2013 Apr;107(4):633-5.
44. Cordeiro de Souza L, Campos JF, Daher LP, Furtado da Silva P, Ventura A, do Prado PZ, et al. Mechanical ventilation weaning in inclusion body myositis: feasibility of isokinetic inspiratory muscle training as an adjunct therapy. Case Rep Crit Care. 2014 Jan;2014:902541.
45. MacIntyre NR, Cook DJ, Ely EW, Epstein SK, Fink JB, Heffner JE, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001 Dec;120(6 Suppl):375S-95S.
46. Su W-L, Chen Y-H, Chen C-W, Yang S-H, Su C-L, Perng W-C, et al. Involuntary cough strength and extubation outcomes for patients in an ICU. Chest. 2010 Apr;137(4):777-82.
47. Wang Z-Y, Bai Y. Cough - another important factor in extubation readiness in critically ill patients. Crit Care. 2012 Nov 13;16(6):461.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email