Inspiratory Muscle Training Strategies in Tracheostomized Critically Ill Individuals

• Published in: Respiratory care 2022-08, Vol.67 (8), p.939-948
• Main Authors: Roceto Ratti, Lígia Dos Santos, Marques Tonella, Rodrigo, Castilho de Figueir do, Luciana, Bredda Saad, Ivete Alonso, Eiras Falcão, Antonio Luis, Martins de Oliveira, Pedro Paulo
• Format: Article
• Language: English
• Subjects: Critical Illness - therapy; Humans; Physical Therapy Modalities; Respiration, Artificial; Respiratory Muscles - physiology; Treatment Outcome; Ventilator Weaning
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.08733

Inspiratory muscle training (IMT) strategies can reduce ICU length of stay and optimize recovery in critically ill patients. Our objective was to compare IMT combined with spontaneous breathing with T-piece in tracheostomized subjects. Tracheostomized critically ill subjects who were ready to wean were selected and randomly allocated to one of 2 groups: electronically-assisted IMT (EIMT) or spontaneous breathing with T-piece. Electronically assisted IMT was delivered using 30% of maximal inspiratory pressure (manual EIMT or automatically adjusted loads). The following variables were analyzed: ICU length of stay, weaning time, maximal inspiratory pressure, rapid shallow breathing index, pressure (cm H O), power (W), flow (L/s), volume (L), and energy (J). A total of 132 patients were assessed; 104 subjects were enrolled with EIMT, 51 (automatic EIMT, 25 and manual EIMT 26), or spontaneous breathing with T-piece group, 53. The Acute Physiology and Chronic Health Evaluation II score was significantly higher = .02) in subjects in the manual EIMT group. Weaning time did not differ significantly between groups (8.55 ± 6.48 d and 10.86 ± 6.48 d, EIMT and spontaneous breathing with T-piece group, respectively; = .23). Weaning success rates (75%) were lower in the manual EIMT group. Invasive mechanical ventilation time was longer but not significantly different ( = .21) in the spontaneous breathing with T-piece group. Maximal inspiratory pressure was significantly higher in the spontaneous breathing with T-piece and the automatic EIMT groups ( < .001 and = .007, respectively). Pressure, power, and energy values were significantly higher in the manual EIMT group ( < .001, = .003, and = .003, respectively). IMT modalities in this trial had no significant impacts on weaning time or successful weaning rates.