Κατεύθυνση Καρδιοπνευμονική Αποκατάσταση και Αποκατάσταση Πασχόντων ΜΕΘLibrary of the School of Health Sciences
Ζακυνθινός Σπυρίδων, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Μεντζελόπουλος Σπυρίδων, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Καλομενίδης Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ο ρόλος της εκγύμνασης των εισπνευστικών μυών στη δύσκολη αποδέσμευση από τον αναπνευστήρα στη ΜΕΘ
The role of inspiratory muscle training in difficult weaning
Inspiratory muscle weakness is a result of mechanical ventilation that constitutes a risk factor for weaning failure in critically ill patients. Research that investigates the use of inspiratory muscle training (IMT) in ventilatory dependent, difficult to be weaned patients, has suggested that this training strategy is associated with successful weaning from mechanical ventilation (MV).
A literature search was conducted in the following databases: PubMed, Scopus and Google scholar. The keywords used were the following inspiratory muscle training, mechanical ventilation, intensive care unit, critical illness, weaning/failure, ventilatory induced diaphragm dysfunction. In the review we included randomized control trials of rehabilitation interventions intended to strengthen the respiratory muscles in critically ill adults.
In this review 11 randomized control trials are included involving critically ill patients. The studies used different devices of training and training protocols. Inspiratory muscle training significantly improved maximal inspiratory pressure and weaning success in comparison with sham or no training group. Additionally, weaning duration decreased, among patients with weaning difficulties. Considering, length of stay or survival either weren’t significantly affected or weren’t measured.
On the condition that diaphragm dysfunction is identified as a reason for weaning failure, a good approach is to improve respiratory muscle function. Inspiratory muscle training contributes to significant improvement of inspiratory muscle strength and leads to successful weaning from MV. Further larger randomized studies are needed to determine the impact of IMT on clinical outcomes, such as duration of mechanical ventilation, successful extubation, ICU-length of stay or survival.
Main subject category:
Inspiratory muscle training, Mechanical ventilation, Intensive Care Unit, Critically ill patient, Weaning, Ventilator induced diaphragm dysfunction
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