Effect of low-intensity inspiratory muscle training on pulmonary rehabilitation in mechanically ventilated patients

doi:10.3877/cma.j.issn.1674-6880.2023.05.004

Abstract

Abstract:

Objective

To explore the effect of low-intensity inspiratory muscle training on mechanically ventilated patients.

Methods

Eighty-one mechanically ventilated patients admitted to the intensive care unit and high dependency unit of the General Hospital of Southern Theatre Command from March 2020 to June 2022 were selected and randomly divided into a control group (41 patients) and an experimental group (40 patients). Six patients were lost to follow-up in the control group and four patients were lost in the experimental group during the trial, and finally 35 patients and 36 patients were included in the two groups, respectively. The control group was treated with conventional therapy, and the experimental group added inspiratory muscle training with 20% maximal inspiratory pressure (MIP) as the starting threshold load to the conventional therapy. After eight weeks of training, patients were assessed for the MIP, change in exertion spirometry, diaphragm thickness, diaphragm mobility, reintubation rate, in-hospital mortality, and quality of life.

Results

After eight weeks of training, the MIP [(29.6 ± 4.8) cmH₂O vs. (20.3 ± 5.5) cmH₂O, t = 6.402, P < 0.001], exertional lung volume [(1 768 ± 655) mL vs. (1 420 ± 420) mL, t = 4.303, P < 0.001], diaphragm mobility [(0.93 ± 0.44) cm vs. (0.79 ± 0.32) cm, t = 2.313, P = 0.023], and modified Barthel index [15 (5, 19) vs. 10 (2, 14), U = 325.500, P = 0.040] of patients in the experimental group were significantly improved compared with the control group. The diaphragm thickness [(1.47 ± 0.38) mm vs. (1.39 ± 0.45) mm, t = 1.195, P = 0.236], reintubation rate [8.3% (3/36) vs. 11.4% (4/35), P = 0.520], and in-hospital mortality [8.3% (3/36) vs. 5.7% (2/35), P = 0.674] were not statistically significantly different between the experimental and control groups.

Conclusion

Low-intensity inspiratory muscle training can significantly improve MIP and exertion spirometry, and may improve diaphragm mobility and quality of life in mechanically ventilated patients.

Key words: Inspiratory muscle training, Mechanical ventilation patients, Pulmonary rehabilitation

Yixuan Dou, Huai Huang, Qiwen Qian, Ranran Xing, Li Lin, Jianfang Bai. Effect of low-intensity inspiratory muscle training on pulmonary rehabilitation in mechanically ventilated patients[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(05): 370-375.

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References 27

1	Hearn E, Gosselink R, Freene N, et al. Inspiratory muscle training in intensive care unit patients: an international cross-sectional survey of physiotherapist practice[J]. Aust Crit Care, 2022, 35 (5): 527-534.
2	Worraphan S, Thammata A, Chittawatanarat K, et al. Effects of inspiratory muscle training and early mobilization on weaning of mechanical ventilation: a systematic review and network meta-analysis[J]. Arch Phys Med Rehabil, 2020, 101 (11): 2002-2014.
3	Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review[J]. J Physiother, 2015, 61 (3): 125-134.
4	Caruso P, Denari SD, Ruiz SA, et al. Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients[J]. Clinics (Sao Paulo), 2005, 60 (6): 479-484.
5	Elbouhy MS, AbdelHalim HA, Hashem AMA. Effect of respiratory muscles training in weaning of mechanically ventilated COPD[J]. Egypt J Chest Dis Tu, 2014, 63 (3): 679-687.
6	Rosa D, Negro A, Marcomini I, et al. The effects of early mobilization on acquired weakness in intensive care units: a literature review[J]. Dimens Crit Care Nurs, 2023, 42 (3): 146-152.
7	Denehy L, Lanphere J, Needham DM. Ten reasons why ICU patients should be mobilized early[J]. Intensive Care Med, 2017, 43 (1): 86-90.
8	Ely EW. The ABCDEF bundle: science and philosophy of how ICU liberation serves patients and families[J]. Crit Care Med, 2017, 45 (2): 321-330.
9	Dres M, Dubé BP, Mayaux J, et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients[J]. Am J Respir Crit Care Med, 2017, 195 (1): 57-66.
10	Fayssoil A, Behin A, Ogna A, et al. Diaphragm: pathophysiology and ultrasound imaging in neuromuscular disorders[J]. J Neuromuscul Dis, 2018, 5 (1): 1-10.
11	王怡洁，田霁松，王淑敏，等.超声评估膈肌功能预测成人机械通气撤机结局[J].中国医学影像技术，2022，38（12）：1893-1896.
12	Derde S, Hermans G, Derese I, et al. Muscle atrophy and preferential loss of myosin in prolonged critically ill patients[J]. Crit Care Med, 2012, 40 (1): 79-89.
13	杨奎，韦正祥，李明新，等.不同营养支持方式对神经重症疾病患者膈肌厚度及预后的影响[J/CD].中华危重症医学杂志（电子版），2022，15（3）：215-219.
14	徐懿苗，邱海波.神经调节辅助通气在呼吸机相关膈肌损伤中的应用进展[J/CD].中华危重症医学杂志（电子版），2022，15（2）：158-162.
15	赵无瑕，赵天玲，李文君.吸气肌训练联合电刺激膈神经对COPD患者膈肌疲劳及肺功能的影响[J].罕少疾病杂志，2023，30（2）：48-49.
16	Bissett B, Leditschke IA, Neeman T, et al. Weaned but weary: one third of adult intensive care patients mechanically ventilated for 7 days or more have impaired inspiratory muscle endurance after successful weaning[J]. Heart Lung, 2015, 44 (1): 15-20.
17	Bissett BM, Leditschke IA, Paratz JD, et al. Protocol: inspiratory muscle training for promoting recovery and outcomes in ventilated patients (IMPROVe): a randomised controlled trial[J]. BMJ Open, 2012, 2 (2): 809-813.
18	Fink H, Helming M, Unterbuchner C, et al. Systemic inflammatory response syndrome increases immobility-induced neuromuscular weakness[J]. Crit Care Med, 2008, 36 (3): 910-916.
19	张娴，臧泽林，赵甜甜，等. ICU患者发生获得性衰弱的危险因素分析[J/CD].中华危重症医学杂志（电子版），2019，12（6）：377-382.
20	Zhang L, Hu W, Cai Z, et al. Early mobilization of critically ill patients in the intensive care unit: a systematic review and meta-analysis[J]. PLoS One, 2019, 14 (10): e0223185.
21	Beaumont M, Forget P, Couturaud F, et al. Effects of inspiratory muscle training in COPD patients: a systematic review and meta-analysis[J]. Clin Respir J, 2018, 12 (7): 2178-2188.
22	Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery[J]. Cochrane Database Syst Rev, 2015, 201 (10): CD010356.
23	Ervin JN, Kahn JM, Cohen TR, et al. Teamwork in the intensive care unit[J]. Am Psychol, 2018, 73 (4): 468-477.
24	Donovan AL, Aldrich JM, Gross AK, et al. Interprofessional care and teamwork in the ICU[J]. Crit Care Med, 2018, 46 (6): 980-990.
25	朱启柱，刘兰，易娟，等.多学科协作临床康复一体化模式下早期肺康复治疗对ICU机械通气患者的影响[J].中国医学创新，2023，20（2）：140-144.
26	Tonella RM, Ratti LDSR, Delazari LEB, et al. Inspiratory muscle training in the intensive care unit: a new perspective[J]. J Clin Med Res, 2017, 9 (11): 929-934.
27	李琳，刘亚平，刘丹丹，等.冠状动脉旁路移植术后患者吸气肌训练效果的系统评价[J].天津护理，2022，30（2）：173-178.

组别	例数	性别（例，男/女）	年龄（岁， ± s）	白蛋白[g/L，M（P₂₅，P₇₅）]	手术史[例（%）]	肺炎[例（%）]
对照组	35	23/12	67 ± 9	30（28，32）	30（85.7）	5（14.3）
试验组	36	21/15	65 ± 13	29（24，32）	32（88.9）	3（8.3）
χ²/t/U值		2.292	1.630	542.500	-	-
P值		0.129	0.107	0.880	0.534	0.619

组别	例数	性别（例，男/女）	年龄（岁， ± s）	白蛋白[g/L，M（P₂₅，P₇₅）]	手术史[例（%）]	肺炎[例（%）]
对照组	35	23/12	67 ± 9	30（28，32）	30（85.7）	5（14.3）
试验组	36	21/15	65 ± 13	29（24，32）	32（88.9）	3（8.3）
χ²/t/U值		2.292	1.630	542.500	-	-
P值		0.129	0.107	0.880	0.534	0.619

组别	例数	MIP（cmH₂O）		用力肺活量（mL）
组别	例数	训练前	训练8周后	训练前	训练8周后
对照组	35	19.2 ± 2.9	20.3 ± 5.5	1 208 ± 331	1 420 ± 420^a
试验组	36	18.9 ± 3.7	29.6 ± 4.8^a	1 134 ± 298	1 768 ± 655^a
t值		1.125	6.402	0.411	4.303
P值		0.265	<0.001	0.683	<0.001

组别	例数	MIP（cmH₂O）		用力肺活量（mL）
组别	例数	训练前	训练8周后	训练前	训练8周后
对照组	35	19.2 ± 2.9	20.3 ± 5.5	1 208 ± 331	1 420 ± 420^a
试验组	36	18.9 ± 3.7	29.6 ± 4.8^a	1 134 ± 298	1 768 ± 655^a
t值		1.125	6.402	0.411	4.303
P值		0.265	<0.001	0.683	<0.001

组别	例数	改良Bathel指数[M（P₂₅，P₇₅）]	再插管率[例（%）]	院内病死率[例（%）]
对照组	35	10（2，14）	4（11.4）	2（5.7）
试验组	36	15（5，19）	3（8.3）	3（8.3）
χ²/U值		325.500	-	-
P值		0.040	0.520	0.674

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