IMT In Mechanical Ventilation: Suitable Protocols And Endpoints, The Key To Clear Results – A Critical Review

“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.”

Conclusion:

“Inspiratory Muscle Training on mechanically ventilated patients seems to be a promissory treatment despite controversial results. Randomised Controlled Trials should be carried out to verify the efficacy of the high intensity training during a suitable period of training using electronic kinetic devices in mechanically ventilated patients.”

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IMT facilitates weaning from mechanical ventilation in ICU

STUDY

Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review

This study, published in the Journal of Physiotherapy, questioned whether Inspiratory Muscle Training (IMT) improves inspiratory muscle strength in adults receiving mechanical ventilation. It also asks if it improves the duration or success of weaning; if it affects the length of stay, reintubation, tracheostomy, survival, or the need for post-extubation non-invasive ventilation; if it’s tolerable; and whether it causes adverse events.

The intervention used was Inspiratory Muscle Training (IMT) versus sham or no IMT.

CONCLUSION

The study revealed that “Inspiratory muscle training improves weaning success, with potential reductions in length of stay and the duration of non-invasive ventilatory support after extubation. Patients who are having difficulty weaning may particularly benefit from the training, especially in weaning success and the duration of mechanical ventilation.”

 

IMT in mechanical ventilation: suitable protocols and endpoints

RESEARCH:

Inspiratory muscle training in mechanical ventilation: suitable protocols and endpoints, the key to clear results – a critical review

Silva, Paulo Eugênio

This research from Faculdade de Educação Física, Universidade de Brasília looked into whether Inspiratory Muscle Training (IMT) led to a shorter duration of mechanical ventilation, improved weaning success, or improved survival.

The purpose of this critical review was to determine:

1. What is the ideal prescription of IMT for patients on MV?
2. What is the best time to measure treatment effect?
3. Which kind of device should be used to IMT?
4. What are the best endpoints to evaluate the effects of IMT on the process of discontinuing from MV?

Which kind of device should be used to IMT? POWERbreathe K-Series.

“The biggest challenge in the training of mechanically ventilated patients is the use of conventional devices to impose loads on the respiratory muscles. When training starts, the patient must be disconnected from the ventilator and the respiratory monitoring is lost.”

“A new class of device is now available that is possible to monitor respiratory variables during the training. One example of this is the POWERbreathe K-Series (POWERbreathe-HaB UK) an electronic K-device with feedback software that helps professionals to understand what is happening with patients during their training. This device provides automatically processed information on external inspiratory work. Moreover, power and breathing patterns during loaded breathing tasks is shown, thus the onset of fatigue can be detected earlier.”

“POWERbreathe K-Series was externally evaluated by Belgian researchers and they concluded that the K-Series technology provides automatically processed and valid estimates of physical units of energy during loaded breathing tasks. Recently, de Souza et al. published a case report showing good results using the same technology to train a prolonged mechanically ventilated patient.”

“Another great advantage of this kind of technology is the capacity of load adjustment (1 cmH2O per 1 cmH2O) reaching 3 to 200 cmH2O. Beyond that, the device can adjust the load dynamically, imposing higher load at the beginning of inspirations and lower load close to vital capacity. Thus, a greater range of motion can be reached improving the effectiveness of the training.”

CONCLUSION:

“This review demonstrated the necessity of new RCTs despite of some well designed RCTs have already been published. Many evidences point out that a high intensity training with loads ≥ 50% of MIP in 5 to 6 sets, aiming to reach thirty breathes, one or twice a day, seven days per week is a suitable protocol to improve performance on mechanical ventilation. Patients must be trained at least for two weeks in order to IMT promotes clinically significant effects. It is possible, that outcomes such as the onset of weaning process, duration and success on the weaning, have higher correlation with IMT.” “In conclusion, IMT on mechanically ventilated patients seems to be a promissory treatment despite controversial results. RCTs should be carried out to verify the efficacy of the high intensity training during a suitable period of training using electronic kinetic devices in mechanically ventilated patients.”

Read Inspiratory muscle training in mechanical ventilation: suitable protocols and endpoints, the key to clear results – a critical review