Abstract
BACKGROUND: 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.
METHODS: 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 H2O), power (W), flow (L/s), volume (L), and energy (J).
RESULTS: A total of 132 patients were assessed; 104 subjects were enrolled with EIMT, n = 51 (automatic EIMT, n = 25 and manual EIMT n = 26), or spontaneous breathing with T-piece group, n = 53. The Acute Physiology and Chronic Health Evaluation II score was significantly higher (P = .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; P = .23). Weaning success rates (75%) were lower in the manual EIMT group. Invasive mechanical ventilation time was longer but not significantly different (P = .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 (P < .001 and P = .007, respectively). Pressure, power, and energy values were significantly higher in the manual EIMT group (P < .001, P = .003, and P = .003, respectively).
CONCLUSIONS: IMT modalities in this trial had no significant impacts on weaning time or successful weaning rates.
- respiratory failure
- critical care
- diaphragm
- weaning
- ICU
- mechanical ventilation
Footnotes
- Correspondence: Lígia dos Santos Roceto Ratti PT PhD, Vital Brasil Street, 251, University City, Campinas, São Paulo, Brazil 13083–888 E-mail: ligiasro{at}unicamp.br
This project was registered in the Brazilian Clinical Trial Registry, registration No. U1111-11563177.
The authors have disclosed no conflicts of interest.
Versions of this paper were presented by Dr Ratti at the European Respiratory Society International Congress 2018, held in Paris, France, September 15–19, 2018; and at the 23rd Brazilian Congress of Intensive Care, held in São Paulo, Brazil, November 29–December 1, 2018.
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