Paulo A F Magalhães1, Carlos A Camillo2, Daniel Langer3, Lívia B Andrade4, Maria do Carmo M B Duarte5, Rik Gosselink6. 1. Maternal and Child Health Doctoral Program, Prof. Fernando Figueira Integral Medicine Institute, Recife, Brazil; KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium. 2. State University of Londrina, Department of Physiotherapy, Londrina, Brazil; KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Leuven, Belgium. 3. KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium; KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Leuven, Belgium. 4. Maternal and Child Health Doctoral Program, Prof. Fernando Figueira Integral Medicine Institute, Recife, Brazil; Federal University of Rio Grande Do Sul, Pneumology Science Postgraduate Program, Porto Alegre, Brazil. 5. Maternal and Child Health Doctoral Program, Prof. Fernando Figueira Integral Medicine Institute, Recife, Brazil. 6. KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium; KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Leuven, Belgium. Electronic address: Rik.Gosselink@kuleuven.be.
Abstract
INTRODUCTION: Respiratory muscle dysfunction, being a common cause of weaning failure, is strongly associated with prolonged mechanical ventilation (MV) and prolonged stay in intensive care units. Inspiratory muscle training (IMT) has been described as an important contributor to the treatment of respiratory muscle dysfunction in critically ill patients. Its effectiveness is however yet controversial. OBJECTIVE: To discuss evidence for assessment of readiness and the effectiveness of interventions for liberation from MV, with special attention to the role of IMT. METHODS: PubMed, LILACS, PEDro and Web of Science were searched for papers of assessment and treatment of patients who failed liberation from MV after at least one attempt published in English or Portuguese until June 2016. RESULTS: Weaning predictors are related to weaning success (86%-100% for sensitivity and 7%-69% for specificity) and work of breathing (73%-100% for sensitivity and 56%-100% for specificity). Spontaneous breathing trials (SBT), noninvasive MV and early mobilization have been reported to improve weaning outcomes. Two modalities of IMT were identified in five selected studies: 1) adjustment of ventilator trigger sensitivity 2) inspiratory threshold loading. Both IMT training modalities promoted significant increases in respiratory muscle strength. IMT with threshold loading showed positive effect on endurance compared to control. CONCLUSION: Methods to indentify respiratory muscle weakness in critically ill patients are feasible and described as indexes that show good accuracy. Individualized and supervised rehabilitation programs including IMT, SBT, noninvasive MV and early mobilization should be encouraged in patients with inspiratory muscle weakness.
INTRODUCTION:Respiratory muscle dysfunction, being a common cause of weaning failure, is strongly associated with prolonged mechanical ventilation (MV) and prolonged stay in intensive care units. Inspiratory muscle training (IMT) has been described as an important contributor to the treatment of respiratory muscle dysfunction in critically illpatients. Its effectiveness is however yet controversial. OBJECTIVE: To discuss evidence for assessment of readiness and the effectiveness of interventions for liberation from MV, with special attention to the role of IMT. METHODS: PubMed, LILACS, PEDro and Web of Science were searched for papers of assessment and treatment of patients who failed liberation from MV after at least one attempt published in English or Portuguese until June 2016. RESULTS: Weaning predictors are related to weaning success (86%-100% for sensitivity and 7%-69% for specificity) and work of breathing (73%-100% for sensitivity and 56%-100% for specificity). Spontaneous breathing trials (SBT), noninvasive MV and early mobilization have been reported to improve weaning outcomes. Two modalities of IMT were identified in five selected studies: 1) adjustment of ventilator trigger sensitivity 2) inspiratory threshold loading. Both IMT training modalities promoted significant increases in respiratory muscle strength. IMT with threshold loading showed positive effect on endurance compared to control. CONCLUSION: Methods to indentify respiratory muscle weakness in critically illpatients are feasible and described as indexes that show good accuracy. Individualized and supervised rehabilitation programs including IMT, SBT, noninvasive MV and early mobilization should be encouraged in patients with inspiratory muscle weakness.
Authors: Karin M Felten-Barentsz; Roel van Oorsouw; Emily Klooster; Niek Koenders; Femke Driehuis; Erik H J Hulzebos; Marike van der Schaaf; Thomas J Hoogeboom; Philip J van der Wees Journal: Phys Ther Date: 2020-08-31
Authors: Thiago De Marchi; Fabiano Frâncio; João Vitor Ferlito; Renata Weigert; Cristiane de Oliveira; Ana Paula Merlo; Délcio Luis Pandini; Bolivar Antônio Pasqual-Júnior; Daniela Giovanella; Shaiane Silva Tomazoni; Ernesto Cesar Leal-Junior Journal: J Inflamm Res Date: 2021-07-24