Effects of inspiratory muscle training at different threshold loads on pulmonary function in critically ill patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

DOU Yixuan ¹ ,  HUANG Huai ² , HE Lian ³ , XING Ranran ² , QIAN Qiwen ² , CHENG Tianhao ¹ , Bai Jianfang ²

1. Graduate School of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510006, P. R. China;
2. Department of Rehabilitation, Critical Care Rehabilitation Centre, General Hospital of the Southern Theatre of the Chinese People’s Liberation Army, Guangzhou, Guangdong 510010, P. R. China;
3. Graduate School of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, P. R. China;

Corresponding?author：

HUANG Huai, Email: haunghuai1999@sina.com

Keywords：

Inspiratory muscle training; critically ill patients; pulmonary function; rehabilitation

DOI：

10.7507/1671-6205.202308010

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Objective To explore the effects of different intensity of inspiratory muscle training on pulmonary function, hospitalisation time and quality of life of critically ill patients. Methods A total of 42 patients were included in the intensive care ward, high dependency ward, and cardiac surgery ward of the Southern Theatre General Hospital from January 2023 to June 2023, and were randomly divided into 14 cases in the control group, 14 cases in the low-intensity inspiratory muscle training group, and 14 cases in the moderate-intensity inspiratory muscle training group; conventional treatment was used for the control group, and 20% of the maximum inspiratory pressure (MIP) was added as the starting threshold load for inspiratory muscle training for the patients of the low-intensity inspiratory muscle training group on the basis of conventional treatment. In the control group, conventional treatment was used; in the low-intensity inspiratory muscle training group, 20% of the maximum inspiratory pressure (MIP) was added to the conventional treatment as the starting threshold load for inspiratory muscle training; in the medium-intensity inspiratory muscle training group, 40% of the MIP was added to the conventional treatment as the starting threshold load for inspiratory muscle training; and the maximal inspiratory pressure, exertional lung capacity, diaphragm thickness and mobility, hospital stay and quality of life were evaluated after 6 weeks of training. Results A total of 40 patients completed the training, and the three groups showed statistically significant differences in MIP (P<0.05) and statistically significant differences in exertional lung capacity (P<0.05). There was no statistically significant difference in diaphragm thickness (P=0.566), and diaphragm mobility was lower in the control group than in the low-intensity inspiratory muscle training group (P=0.021), and there was also a difference between the low-intensity inspiratory muscle training group and the moderate-intensity inspiratory muscle training group (P=0.036); there was a difference in the length of stay in the care unit among the three groups (P=0.034), and there was no statistically different (P=0.149), and the duration of hospital stay was significantly shorter in the moderate intensity inspiratory muscle training group compared to the control group (P=0.016). Medium-intensity inspiratory muscle training can significantly improve patients' quality of life compared with the control group and low-intensity inspiratory muscle training group (P<0.05). Conclusions Both low-intensity inspiratory muscle training and moderate-intensity inspiratory muscle training can enhance the lung function of critically ill patients, improve their diaphragm mobility, and promote their pulmonary rehabilitation. Medium-intensity inspiratory muscle training was significantly better than low-intensity inspiratory muscle training in improving the lung function of patients. Moreover, moderate-intensity inspiratory muscle training may have positive significance in improving patients' quality of life and shortening their hospitalisation time.

Citation： DOU Yixuan, HUANG Huai, HE Lian, XING Ranran, QIAN Qiwen, CHENG Tianhao, Bai Jianfang. Effects of inspiratory muscle training at different threshold loads on pulmonary function in critically ill patients. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(10): 702-709. doi: 10.7507/1671-6205.202308010 Copy

1.	Dres M, Dubé BP, Mayaux J, et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. Am J Respir Crit Care Med, 2017, 195(1): 57-66.
2.	Bissett BM, Wang J, Neeman T, et al. Which ICU patients benefit most from inspiratory muscle training? Retrospective analysis of a randomized trial. Physiother Theory Pract, 2020, 36(12): 1316-1321.
3.	Hearn E, Gosselink R, Freene N, et al. Inspiratory muscle training in intensive care unit patients: an international cross-sectional survey of physiotherapist practice. Aust Crit Care, 2022, 35(5): 527-534.
4.	Worraphan S, Thammata A, Chittawatanarat K, et al. Effects of inspiratory muscle training and early mobilization on weaning of mechanical ventilation: a systematic review and network meta-analysis. Arch Phys Med Rehabil, 2020, 101(11): 2002-2014.
5.	Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review. J Physiother, 2015, 61(3): 125-134.
6.	Bissett B, Leditschke IA, Green M, et al. Inspiratory muscle training for intensive care patients: a multidisciplinary practical guide for clinicians. Aust Crit Care, 2019, 32(3): 249-255.
7.	Bissett B, Gosselink R, Van Haren FM. Respiratory muscle rehabilitation in patients with prolonged mechanical ventilation: a targeted approach. Crit Care, 2020, 24(1): 103.
8.	Vorona S, Sabatini U, Al-Maqbali S, et al. Inspiratory muscle rehabilitation in critically ill adults. A systematic review and meta-analysis. Ann Am Thorac Soc, 2018, 15(6): 735-744.
9.	Bissett BM, Leditschke IA, Neeman T, et al. Does mechanical threshold inspiratory muscle training promote recovery and improve outcomes in patients who are ventilator-dependent in the intensive care unit? The IMPROVE randomised trial. Aust Crit Care, 2023, 36(4): 613-621.
10.	Caruso P, Denari SD, Ruiz SA, et al. Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients. Clinics, 2005, 60(6): 479-484.
11.	Mohammed S, Elbouhy MS, Abdelhalim HA, et al. Effect of respiratory muscles training in weaning of mechanically ventilated COPD patients. Egypt J Chest Dis Tuberc, 2014, 63(3): 679-687.
12.	Rosa D, Negro A, Marcomini I, et al. The effects of early mobilization on acquired weakness in intensive care units: a literature review. Dimens Crit Care Nurs, 2023, 42(3): 146-152.
13.	Dres M, Goligher EC, Heunks LMA, et al. Critical illness-associated diaphragm weakness. Intensive Care Med, 2017, 43(10): 1441-1452.
14.	王怡潔, 田霽松, 王淑敏, 等. 超聲評估膈肌功能預測成人機械通氣撤機結局. 中國醫學影像技術, 2022, 38(12): 1893-1896.
15.	Derde S, Hermans G, Derese I, et al. Muscle atrophy and preferential loss of myosin in prolonged critically ill patients. Crit Care Med, 2012, 40(1): 79-89.
16.	Bissett B, Leditschke IA, Neeman T, et al. Weaned but weary: one third of adult intensive care patients mechanically ventilated for 7 days or more have impaired inspiratory muscle endurance after successful weaning. Heart Lung, 2015, 44(1): 15-20.
17.	Bissett BM, Leditschke IA, Paratz JD, et al. Protocol: inspiratory muscle training for promoting recovery and outcomes in ventilated patients (IMPROVe): a randomised controlled trial. BMJ Open, 2012, 2(2): 809-813.
18.	Fink H, Helming M, Unterbuchner C, et al. Systemic inflammatory response syndrome increases immobility-induced neuromuscular weakness. Crit Care Med, 2008, 36(3): 910-916.
19.	張嫻, 臧澤林, 趙甜甜, 等. ICU患者發生獲得性衰弱的危險因素分析. 中華危重癥醫學雜志(電子版), 2019, 12(6): 377-382.
20.	Zhang L, Hu W, Cai Z, et al. Early mobilization of critically ill patients in the intensive care unit: a systematic review and meta-analysis. PLoS One, 2019, 14(10): e0223185.
21.	Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev, 2018, 3(3): CD010754.
22.	Kim WY, Suh HJ, Hong SB, et al. Diaphragm dysfunction assessed by ultrasonograp-hy: infuence on weaning from mechanical ventilation. Crit Care Med, 2011, 39(12): 2627-2630.
23.	Lerolle N, Guérot E, Dimassi S, et al. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest, 2009, 135: 401-407.
24.	Demoule A, Jung B, Prodanovic H et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact — a prospective study. Am J Respir Crit Care Med, 2013, 188(2): 213-219.
25.	楊奎, 韋正祥, 李明新, 等. 不同營養支持方式對神經重癥疾病患者膈肌厚度及預后的影響. 中華危重癥醫學雜志(電子版), 2022, 15(3): 215-219.
26.	趙無瑕, 趙天玲, 李文君. 吸氣肌訓練聯合電刺激膈神經對COPD患者膈肌疲勞及肺功能的影響. 罕少疾病雜志, 2023, 30(2): 48-49.
27.	劉鋼, 胡少華, 段宗浩, 等. 多學科協作模式下早期分級呼吸重癥康復訓練應用于機械通氣患者效果研究. 中國呼吸與危重監護雜志, 2021, 20(4): 254-260.
28.	Ervin JN, Kahn JM, Cohen TR, et al. Teamwork in the intensive care unit. Am Psychol, 2018, 73(4): 468-477.
29.	Donovan AL, Aldrich JM, Gross AK, et al. Interprofessional care and teamwork in the ICU. Crit Care Med, 2018, 46(6): 980-990.
30.	Tonella RM, Ratti LDSR, Delazari LEB, et al. Inspiratory muscle training in the intensive care unit: a new perspective. J Clin Med Res, 2017, 9(11): 929-934.
31.	李琳, 劉亞平, 劉丹丹, 等. 冠狀動脈旁路移植術后患者吸氣肌訓練效果的系統評價. 天津護理, 2022, 30(2): 173-178.

1. Dres M, Dubé BP, Mayaux J, et al. Coexistence and impact of limb muscle and diaphragm weakness at time of liberation from mechanical ventilation in medical intensive care unit patients. Am J Respir Crit Care Med, 2017, 195(1): 57-66.
2. Bissett BM, Wang J, Neeman T, et al. Which ICU patients benefit most from inspiratory muscle training? Retrospective analysis of a randomized trial. Physiother Theory Pract, 2020, 36(12): 1316-1321.
3. Hearn E, Gosselink R, Freene N, et al. Inspiratory muscle training in intensive care unit patients: an international cross-sectional survey of physiotherapist practice. Aust Crit Care, 2022, 35(5): 527-534.
4. Worraphan S, Thammata A, Chittawatanarat K, et al. Effects of inspiratory muscle training and early mobilization on weaning of mechanical ventilation: a systematic review and network meta-analysis. Arch Phys Med Rehabil, 2020, 101(11): 2002-2014.
5. Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review. J Physiother, 2015, 61(3): 125-134.
6. Bissett B, Leditschke IA, Green M, et al. Inspiratory muscle training for intensive care patients: a multidisciplinary practical guide for clinicians. Aust Crit Care, 2019, 32(3): 249-255.
7. Bissett B, Gosselink R, Van Haren FM. Respiratory muscle rehabilitation in patients with prolonged mechanical ventilation: a targeted approach. Crit Care, 2020, 24(1): 103.
8. Vorona S, Sabatini U, Al-Maqbali S, et al. Inspiratory muscle rehabilitation in critically ill adults. A systematic review and meta-analysis. Ann Am Thorac Soc, 2018, 15(6): 735-744.
9. Bissett BM, Leditschke IA, Neeman T, et al. Does mechanical threshold inspiratory muscle training promote recovery and improve outcomes in patients who are ventilator-dependent in the intensive care unit? The IMPROVE randomised trial. Aust Crit Care, 2023, 36(4): 613-621.
10. Caruso P, Denari SD, Ruiz SA, et al. Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients. Clinics, 2005, 60(6): 479-484.
11. Mohammed S, Elbouhy MS, Abdelhalim HA, et al. Effect of respiratory muscles training in weaning of mechanically ventilated COPD patients. Egypt J Chest Dis Tuberc, 2014, 63(3): 679-687.
12. Rosa D, Negro A, Marcomini I, et al. The effects of early mobilization on acquired weakness in intensive care units: a literature review. Dimens Crit Care Nurs, 2023, 42(3): 146-152.
13. Dres M, Goligher EC, Heunks LMA, et al. Critical illness-associated diaphragm weakness. Intensive Care Med, 2017, 43(10): 1441-1452.
14. 王怡潔, 田霽松, 王淑敏, 等. 超聲評估膈肌功能預測成人機械通氣撤機結局. 中國醫學影像技術, 2022, 38(12): 1893-1896.
15. Derde S, Hermans G, Derese I, et al. Muscle atrophy and preferential loss of myosin in prolonged critically ill patients. Crit Care Med, 2012, 40(1): 79-89.
16. Bissett B, Leditschke IA, Neeman T, et al. Weaned but weary: one third of adult intensive care patients mechanically ventilated for 7 days or more have impaired inspiratory muscle endurance after successful weaning. Heart Lung, 2015, 44(1): 15-20.
17. Bissett BM, Leditschke IA, Paratz JD, et al. Protocol: inspiratory muscle training for promoting recovery and outcomes in ventilated patients (IMPROVe): a randomised controlled trial. BMJ Open, 2012, 2(2): 809-813.
18. Fink H, Helming M, Unterbuchner C, et al. Systemic inflammatory response syndrome increases immobility-induced neuromuscular weakness. Crit Care Med, 2008, 36(3): 910-916.
19. 張嫻, 臧澤林, 趙甜甜, 等. ICU患者發生獲得性衰弱的危險因素分析. 中華危重癥醫學雜志(電子版), 2019, 12(6): 377-382.
20. Zhang L, Hu W, Cai Z, et al. Early mobilization of critically ill patients in the intensive care unit: a systematic review and meta-analysis. PLoS One, 2019, 14(10): e0223185.
21. Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev, 2018, 3(3): CD010754.
22. Kim WY, Suh HJ, Hong SB, et al. Diaphragm dysfunction assessed by ultrasonograp-hy: infuence on weaning from mechanical ventilation. Crit Care Med, 2011, 39(12): 2627-2630.
23. Lerolle N, Guérot E, Dimassi S, et al. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest, 2009, 135: 401-407.
24. Demoule A, Jung B, Prodanovic H et al. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact — a prospective study. Am J Respir Crit Care Med, 2013, 188(2): 213-219.
25. 楊奎, 韋正祥, 李明新, 等. 不同營養支持方式對神經重癥疾病患者膈肌厚度及預后的影響. 中華危重癥醫學雜志(電子版), 2022, 15(3): 215-219.
26. 趙無瑕, 趙天玲, 李文君. 吸氣肌訓練聯合電刺激膈神經對COPD患者膈肌疲勞及肺功能的影響. 罕少疾病雜志, 2023, 30(2): 48-49.
27. 劉鋼, 胡少華, 段宗浩, 等. 多學科協作模式下早期分級呼吸重癥康復訓練應用于機械通氣患者效果研究. 中國呼吸與危重監護雜志, 2021, 20(4): 254-260.
28. Ervin JN, Kahn JM, Cohen TR, et al. Teamwork in the intensive care unit. Am Psychol, 2018, 73(4): 468-477.
29. Donovan AL, Aldrich JM, Gross AK, et al. Interprofessional care and teamwork in the ICU. Crit Care Med, 2018, 46(6): 980-990.
30. Tonella RM, Ratti LDSR, Delazari LEB, et al. Inspiratory muscle training in the intensive care unit: a new perspective. J Clin Med Res, 2017, 9(11): 929-934.
31. 李琳, 劉亞平, 劉丹丹, 等. 冠狀動脈旁路移植術后患者吸氣肌訓練效果的系統評價. 天津護理, 2022, 30(2): 173-178.

Chinese Journal of Respiratory and Critical Care Medicine

Effects of inspiratory muscle training at different threshold loads on pulmonary function in critically ill patients

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