PT  - JOURNAL ARTICLE
AU  - Lígia dos Santos Roceto Ratti
AU  - Rodrigo Marques Tonella
AU  - Luciana Castilho de Figueir≖do
AU  - Ivete Alonso Bredda Saad
AU  - Antonio Luis Eiras Falcão
AU  - Pedro Paulo Martins de Oliveira
TI  - Inspiratory Muscle Training Strategies in Tracheostomized Critically Ill Individuals
AID  - 10.4187/respcare.08733
DP  - 2022 Aug 01
TA  - Respiratory Care
PG  - 939--948
VI  - 67
IP  - 8
4099  - http://rc.rcjournal.com/content/67/8/939.short
4100  - http://rc.rcjournal.com/content/67/8/939.full
AB  - 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.