Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians

Abstract

This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.

Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical Ventilation: A Targeted Approach

“…Clearly respiratory muscle atrophy is an important aspect of ICU-acquired weakness, and we can no longer afford to ignore respiratory muscle rehabilitation as part of holistic recovery for ICU survivors. Identification of respiratory muscle weakness, and early commencement of targeted training, requires effective collaboration of the whole ICU multidisciplinary team, but in particular a cohesive approach between medical, nursing, and physiotherapy staff [14].…”

“…For cooperative patients recently weaned from mechanical ventilation, measurement of maximal inspiratory pressure can be feasibly done through either the mouth Fig. 1 Handheld respiratory pressure manometer connected to endotracheal tube for measurement of maximal inspiratory pressure (Reproduced from [14] with permission) or a tracheostomy using a handheld manometer [14]. However, even if ICU clinicians do not have access to this device, lack of measurement does not preclude appropriate therapy.…”

“…Indeed, the expiratory muscles have been described as the "neglected component" of the respiratory system in a recent comprehensive review that describes expiratory muscle physiology in ICU patients [25]. In the most recent systematic review of respiratory muscle training in ICU patients [22], four studies of expiratory muscle training (comprising 153 participants) were metaanalyzed, revealing a mean difference of 9 cmH 2 O (95% CI [5][6][7][8][9][10][11][12][13][14] in favor of the training group relative to control. However, the effect of expiratory muscle training on patient outcomes requires further exploration in an ICU context.…”

“…While we have been using inspiratory muscle training in our ICU for the past 15 years [14], we are aware that such training is a relatively new approach for many ICU clinicians. Moreover, where inspiratory muscle training is being used around the world, a wide variety of approaches is being employed, and not all of these are evidence-based.…”

“…In this approach, the patient is briefly removed from the ventilator, and the inspiratory muscle trainer is connected to the endotracheal tube or tracheostomy for training (i.e., breathing through the valve). The intensity is increased over time simply by winding the spring more tightly [14]. This device has been shown to be safe for inspiratory muscle training in selected ventilator-dependent ICU patients, with a negligible rate of adverse events [35].…”