Improving weaning from mechanical ventilation: understanding the role of inspiratory muscle training in difficult to wean patients.

A majority of mechanically ventilated patients develop respiratory muscle weakness during critical illness. Rehabilitation efforts in the ICU have so far largely been focused on peripheral muscle dysfunction, whereas respiratory muscle rehabilitation has received relatively less attention. The potential value of implementing rehabilitative interventions for respiratory muscle conditioning are supported by observations showing that respiratory muscle weakness is associated with prolonged duration of mechanical ventilation, difficult weaning, and increased ICU mortality. In two recent systematic reviews it was observed that inspiratory muscle training (IMT) can improve respiratory muscle function, and might facilitate weaning from mechanical ventilation. Confidence in the pooled estimates that were obtained was however low, owing mainly to methodological limitations, including substantial statistical and methodological heterogeneity between studies. Moreover, despite a strong theoretical rationale and some evidence supporting its use, mechanistic studies evaluating physiological adaptations that occur in respiratory muscles of mechanically ventilated patients in response to different training regimens have not been performed so far. The optimal approach to IMT therefore remains largely uncertain. In order to gain more insight into how an optimal training stimulus should be offered to patients on prolonged mechanical ventilation we therefore aim to perform comprehensive evaluations of physiological adaptations and changes in both static and dynamic respiratory muscle function in response to three different training regimens in patients on prolonged mechanical ventilation.

Keywords:Inspiratory Muscle Training, Mechanical ventilation, Weaning

Disciplines:Rehabilitation sciences not elsewhere classified