Changes in peak cough flow and diaphragmatic function after combined abdominal weight training and mechanical insufflation-exsufflation (MI-E) intervention and their predictive value for successful weaning_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

XIE Xiaomin , CAO Jing , ZHANG Yanmei , WU Jingjing , MAO Xiaojuan ,  ZHAO Huan

Department of Respiratory Medicine, Nantong Sixth People's Hospital (Affiliated Hospital of Shanghai University), Nantong, Jiangsu 226000, P. R. China;

Corresponding?author：

ZHAO Huan, Email: zhaohuan0525@126.com

Keywords：

Severe pneumonia; mechanical ventilation; peak cough flow; diaphragmatic function; weaning; predictive model

DOI：

10.7507/1671-6205.202605097

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effects of combined abdominal weight training and mechanical insufflation-exsufflation (MI-E) on peak cough flow (PCF) and diaphragmatic function in patients with severe pneumonia undergoing invasive mechanical ventilation, and evaluate the predictive value of PCF combined with diaphragmatic ultrasound parameters for weaning success. Methods A prospective randomized controlled trial was conducted. A total of 105 patients with severe pneumonia undergoing mechanical ventilation were enrolled and randomly divided into three groups: a basic care group (Group A), an abdominal weight-loading group (Group B), and an abdominal weight-loading combined with MI-E group (Group C). Ultimately, 96 patients completed the study, with 32 patients in each group. All three groups received the corresponding interventions for 7 days. On day 1 and day 7 of the intervention, the following parameters were measured: peak cough flow (PCF), maximal inspiratory pressure (MIP), maximum transdiaphragmatic pressure (Pdimax), diaphragmatic excursion (DD), diaphragmatic thickening fraction (DTF), and diaphragmatic rapid shallow breathing index (D-RSBI). After one week of intervention, a spontaneous breathing trial (SBT) was performed to assess the weaning success rate. Results Compared with Group A and Group B, Group C showed significantly higher PCF, DD, DTF, MIP and Pdimax on day 7 (all P<0.05), and significantly lower D-RSBI (P<0.05). The weaning success rates in the three groups were 34.4% (11/32) in Group A, 56.2% (18/32) in Group B, and 78.1% (25/32) in Group C, with Group C being significantly higher than Group A and Group B (P<0.05). The patients in the weaning success group (n=54) had higher PCF, DD, DTF, and MIP, and lower D-RSBI compared with the weaning failure group (n=42) (all P<0.05). Multivariate logistic regression with weaning failure as outcome showed that higher PCF (OR=0.89, 95%CI 0.83-0.95), DD (OR=0.72, 95%CI 0.60-0.87), and DTF (OR=0.92, 95%CI 0.86-0.97) were protective factors against weaning failure (all P<0.05), while higher D-RSBI (OR=1.15, 95%CI 1.05-1.26) was a risk factor (P=0.002). Receiver operating characteristic curve analysis showed that the areas under the curve (AUC) for PCF, DD, DTF, and D-RSBI in predicting weaning success were 0.81, 0.78, 0.80, and 0.75, respectively, while the AUC of the combined PCF+DD+DTF model reached 0.91 (95%CI 0.86-0.96), with a sensitivity of 87.7% and a specificity of 87.1%. Conclusions Abdominal weight training combined with MI-E can significantly improve peak cough flow, diaphragmatic function, and weaning success rate in mechanically ventilated patients with severe pneumonia. The prediction model combining PCF, DD, and DTF demonstrates excellent predictive value for weaning success.

1.	Ferrer M, De Pascale G, Tanzarella ES, et al. Severe community-acquired pneumonia: noninvasive mechanical ventilation, intubation, and HFNT[J]. Semin Respir Crit Care Med, 2024, 45(2): 169-186.
2.	Powers SK. Ventilator-induced diaphragm dysfunction: phenomenology and mechanism(s) of pathogenesis[J]. J Physiol, 2024, 602(19): 4729-4752.
3.	Zhou Q, Xu Y, Chen J, et al. Prediction of weaning outcomes from mechanical ventilation in critically ill patients based on the combination of ultrasound parameters of the heart, lung, and diaphragm: a prospective observational cohort study[J]. Quant Imaging Med Surg, 2025, 15(9): 7697-7710.
4.	Zhang J, Xie Q, Jiang R, et al. Role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation: a prospective cohort study[J]. J Crit Care, 2024, 86: 154983.
5.	Murata K, Shimoyama K, Tsuruya T, et al. Investigating the risk of reintubation by cough force assessment using cough peak expiratory flow: a single-center observational pilot study[J]. BMC Pulm Med, 2024, 24: 222.
6.	Fu W, Guan L, Liu Q, et al. Ventilator-induced diaphragmatic dysfunction: pathophysiology, monitoring and advances in potential treatment and prevention[J]. Eur Respir Rev, 2025, 34(178): 250069.
7.	中國醫師協會急診醫師分會. 中國急診重癥肺炎臨床實踐專家共識[J]. 中國急救醫學, 2016, 36(2): 97-107.
8.	Hung TY, Wu WL, Kuo HC, et al. Effect of abdominal weight training with and without cough machine assistance on lung function in the patients with prolonged mechanical ventilation: a randomized trial[J]. Crit Care, 2022, 26: 153.
9.	Andersen TM, Hov B, Halvorsen T, et al. Upper airway assessment and responses during mechanically assisted cough: a narrative review[J]. Respir Care, 2021, 66(8): 1325-1336.
10.	Parada-Gereda HM, Tibaduiza AL, Rico-Mendoza A, et al. Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis[J]. Crit Care, 2023, 27(1): 174.
11.	鐘林, 姜建平, 盛菊萍. 膈肌淺快呼吸指數聯合最大吸氣壓力對機械通氣患者撤機結局的預測價值[J]. 浙江醫學, 2024, 46(12): 1275-1279.
12.	Bianchini A, Pintus L, Vitale G, et al. Lung ultrasound in mechanical ventilation: a purposive review[J]. Diagnostics (Basel), 2025, 15(7): 870.
13.	羅璇, 陳燕, 張楠, 等. 膈肌超聲在機械通氣脫機評估中的應用進展[J]. 中華危重病急救醫學, 2022, 34(5): 550-554.
14.	Song J, Qian Z, Zhang H, et al. Diaphragmatic ultrasonography-based rapid shallow breathing index for predicting weaning outcome during a pressure support ventilation spontaneous breathing trial[J]. BMC Pulm Med, 2022, 22(1): 337.
15.	Duan J, Zhang X, Song J. Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis[J]. Crit Care, 2021, 25(1): 357.
16.	Brennan M, McDonnell MJ, Duignan N, et al. The use of cough peak flow in the assessment of respiratory function in clinical practice-A narrative literature review[J]. Respir Med, 2022, 193: 106740.
17.	Ferreira NA, Ferreira AS, Guimar?es FS. Cough peak flow to predict extubation outcome: a systematic review and meta-analysis[J]. Rev Bras Ter Intensiva, 2021, 33(3): 445-456.
18.	Springer Nature. Airway clearance techniques and weaning[M]. Cham: Springer, 2025: Chapter 16.
19.	Norisue Y, Santanda T, Nabeshima T, et al. Association of diaphragm movement during cough, as assessed by ultrasonography, with extubation outcome[J]. Respir Care, 2021, 66(11): 1713-1719.
20.	Yi LJ, Tian X, Chen M, et al. Comparative efficacy and safety of four different spontaneous breathing trials for weaning from mechanical ventilation: a systematic review and network meta-Analysis[J]. Front Med (Lausanne), 2021, 8: 731196.
21.	Schulz A, Erbuth A, Boyko M, et al. Comparison of ultrasound measurements for diaphragmatic mobility, diaphragmatic thickness, and diaphragm thickening fraction with each other and with lung function in patients with chronic obstructive pulmonary disease[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17: 2217-2227.
22.	Poddighe D, Van Hollebeke M, Choudhary YQ, et al. Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis[J]. Crit Care, 2024, 28(1): 70.

1. Ferrer M, De Pascale G, Tanzarella ES, et al. Severe community-acquired pneumonia: noninvasive mechanical ventilation, intubation, and HFNT[J]. Semin Respir Crit Care Med, 2024, 45(2): 169-186.
2. Powers SK. Ventilator-induced diaphragm dysfunction: phenomenology and mechanism(s) of pathogenesis[J]. J Physiol, 2024, 602(19): 4729-4752.
3. Zhou Q, Xu Y, Chen J, et al. Prediction of weaning outcomes from mechanical ventilation in critically ill patients based on the combination of ultrasound parameters of the heart, lung, and diaphragm: a prospective observational cohort study[J]. Quant Imaging Med Surg, 2025, 15(9): 7697-7710.
4. Zhang J, Xie Q, Jiang R, et al. Role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation: a prospective cohort study[J]. J Crit Care, 2024, 86: 154983.
5. Murata K, Shimoyama K, Tsuruya T, et al. Investigating the risk of reintubation by cough force assessment using cough peak expiratory flow: a single-center observational pilot study[J]. BMC Pulm Med, 2024, 24: 222.
6. Fu W, Guan L, Liu Q, et al. Ventilator-induced diaphragmatic dysfunction: pathophysiology, monitoring and advances in potential treatment and prevention[J]. Eur Respir Rev, 2025, 34(178): 250069.
7. 中國醫師協會急診醫師分會. 中國急診重癥肺炎臨床實踐專家共識[J]. 中國急救醫學, 2016, 36(2): 97-107.
8. Hung TY, Wu WL, Kuo HC, et al. Effect of abdominal weight training with and without cough machine assistance on lung function in the patients with prolonged mechanical ventilation: a randomized trial[J]. Crit Care, 2022, 26: 153.
9. Andersen TM, Hov B, Halvorsen T, et al. Upper airway assessment and responses during mechanically assisted cough: a narrative review[J]. Respir Care, 2021, 66(8): 1325-1336.
10. Parada-Gereda HM, Tibaduiza AL, Rico-Mendoza A, et al. Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis[J]. Crit Care, 2023, 27(1): 174.
11. 鐘林, 姜建平, 盛菊萍. 膈肌淺快呼吸指數聯合最大吸氣壓力對機械通氣患者撤機結局的預測價值[J]. 浙江醫學, 2024, 46(12): 1275-1279.
12. Bianchini A, Pintus L, Vitale G, et al. Lung ultrasound in mechanical ventilation: a purposive review[J]. Diagnostics (Basel), 2025, 15(7): 870.
13. 羅璇, 陳燕, 張楠, 等. 膈肌超聲在機械通氣脫機評估中的應用進展[J]. 中華危重病急救醫學, 2022, 34(5): 550-554.
14. Song J, Qian Z, Zhang H, et al. Diaphragmatic ultrasonography-based rapid shallow breathing index for predicting weaning outcome during a pressure support ventilation spontaneous breathing trial[J]. BMC Pulm Med, 2022, 22(1): 337.
15. Duan J, Zhang X, Song J. Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis[J]. Crit Care, 2021, 25(1): 357.
16. Brennan M, McDonnell MJ, Duignan N, et al. The use of cough peak flow in the assessment of respiratory function in clinical practice-A narrative literature review[J]. Respir Med, 2022, 193: 106740.
17. Ferreira NA, Ferreira AS, Guimar?es FS. Cough peak flow to predict extubation outcome: a systematic review and meta-analysis[J]. Rev Bras Ter Intensiva, 2021, 33(3): 445-456.
18. Springer Nature. Airway clearance techniques and weaning[M]. Cham: Springer, 2025: Chapter 16.
19. Norisue Y, Santanda T, Nabeshima T, et al. Association of diaphragm movement during cough, as assessed by ultrasonography, with extubation outcome[J]. Respir Care, 2021, 66(11): 1713-1719.
20. Yi LJ, Tian X, Chen M, et al. Comparative efficacy and safety of four different spontaneous breathing trials for weaning from mechanical ventilation: a systematic review and network meta-Analysis[J]. Front Med (Lausanne), 2021, 8: 731196.
21. Schulz A, Erbuth A, Boyko M, et al. Comparison of ultrasound measurements for diaphragmatic mobility, diaphragmatic thickness, and diaphragm thickening fraction with each other and with lung function in patients with chronic obstructive pulmonary disease[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17: 2217-2227.
22. Poddighe D, Van Hollebeke M, Choudhary YQ, et al. Accuracy of respiratory muscle assessments to predict weaning outcomes: a systematic review and comparative meta-analysis[J]. Crit Care, 2024, 28(1): 70.

Chinese Journal of Respiratory and Critical Care Medicine

Latest ArticlesChanges in peak cough flow and diaphragmatic function after combined abdominal weight training and mechanical insufflation-exsufflation (MI-E) intervention and their predictive value for successful weaning

Abstract Full text Figures/Tables Video References Cited by

Format

Content