1
|
Iqbal M, Hassan K, Bliss E, Whiteside EJ, Hoffman B, Mills DE. The effects of inspiratory muscle training on biomarkers of muscle damage in recovered COVID-19 patients after weaning from mechanical ventilation. Chron Respir Dis 2024; 21:14799731241289423. [PMID: 39365635 PMCID: PMC11457248 DOI: 10.1177/14799731241289423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 09/13/2024] [Indexed: 10/05/2024] Open
Abstract
Background: COVID-19 patients experience respiratory muscle damage, leading to reduced respiratory function and functional capacity often requiring mechanical ventilation which further increases susceptibility to muscle weakness. Inspiratory muscle training (IMT) may help mitigate this damage and improve respiratory function and functional capacity. Methods: We studied the effects of IMT on muscle damage biomarkers, respiratory function, and functional capacity in COVID-19 recovered young adults, successfully weaned from mechanical ventilation. Participants were randomly allocated to either an IMT (n = 11) or control (CON; n = 11) intervention for 4 weeks. The IMT group performed 30 dynamic inspiratory efforts twice daily, at 50% of their maximal inspiratory mouth pressure (PMmax) while the CON group performed 60 inspiratory efforts at 10% of pMmax daily. Serum was collected at baseline, week two, and week four to measure creatine kinase muscle-type (CKM), fast skeletal troponin-I (sTnI) and slow sTnI. Results: Time × group interaction effects were observed for CKM and slow sTnI, but not for fast sTnI. Both were lower at two and 4 weeks for the IMT compared to the CON group, respectively. Time × group interaction effects were observed for forced expiratory volume in 1s, forced vital capacity, PMmax and right- and left-hand grip strength. These were higher for the IMT compared to the CON group. Conclusion: Four weeks of IMT decreased muscle damage biomarkers and increased respiratory function and grip strength in recovered COVID-19 patients after weaning from mechanical ventilation.
Collapse
Affiliation(s)
- Muneeb Iqbal
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- Respiratory and Exercise Physiology Research Group, School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
| | - Kumail Hassan
- Department of Physiotherapy, University of Lahore Teaching Hospital, Lahore, Pakistan
| | - Edward Bliss
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- Respiratory and Exercise Physiology Research Group, School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
| | - Eliza J Whiteside
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Future Materials, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Ben Hoffman
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
| | - Dean E Mills
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- Respiratory and Exercise Physiology Research Group, School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
- Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
| |
Collapse
|
2
|
Mahran GSK, Mehany MM, Abbas MS, Shehata AE, AbdElhafeez AS, Obiedallah AA, Mohamed SA. Short-Term Outcomes of Neuromuscular Electrical Stimulation in Critically Ill Patients. Crit Care Nurs Q 2023; 46:126-135. [PMID: 36823739 DOI: 10.1097/cnq.0000000000000445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Muscle weakness acquired in the intensive care unit (ICU) adversely affects outcomes of ICU patients. This article reports the short-term respiratory effects of neuromuscular electrical stimulation (NMES) in critically ill patients. Patients were randomly assigned to an intervention group (NMES + conventional physiotherapy) and a control group (sham NMES + conventional physiotherapy). The application of NMES in the intervention group resulted in a significant decrease in the duration of mechanical ventilation and reduced the number of weaning trial failures. Other positive outcomes included reductions in the length of ICU stays and decreased mortality when compared with the control group.
Collapse
Affiliation(s)
- Ghada S K Mahran
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt (Drs Mahran and Mehany); Departments of Anesthesia and Intensive Care (Drs Abbas and Shehata), Medical Physiology (Dr AbdElhafeez), Internal Medicine, Cardiology and Critical Care Medicine Unit (Dr Obiedallah), and Chest Diseases and Tuberculosis (Mohamed), Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | | | | | | | | |
Collapse
|
3
|
De Marchi T, Frâncio F, Ferlito JV, Weigert R, de Oliveira C, Merlo AP, Pandini DL, Pasqual-Júnior BA, Giovanella D, Tomazoni SS, Leal-Junior EC. Effects of Photobiomodulation Therapy Combined with Static Magnetic Field in Severe COVID-19 Patients Requiring Intubation: A Pragmatic Randomized Placebo-Controlled Trial. J Inflamm Res 2021; 14:3569-3585. [PMID: 34335043 PMCID: PMC8318710 DOI: 10.2147/jir.s318758] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/10/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose We aimed to investigate the effects of photobiomodulation therapy combined with static magnetic field (PBMT-sMF) on the length of intensive care unit (ICU) stay and mortality rate of severe COVID-19 patients requiring invasive mechanical ventilation and assess its role in preserving respiratory muscles and modulating inflammatory processes. Patients and Methods We conducted a prospectively registered, triple-blinded, randomized, placebo-controlled trial of PBMT-sMF in severe COVID-19 ICU patients requiring invasive mechanical ventilation. Patients were randomly assigned to receive either PBMT-sMF or a placebo daily throughout their ICU stay. The primary outcome was length of ICU stay, defined by either discharge or death. The secondary outcomes were survival rate, diaphragm muscle function, and the changes in blood parameters, ventilatory parameters, and arterial blood gases. Results Thirty patients were included and equally randomized into the two groups. There were no significant differences in the length of ICU stay (mean difference, MD = −6.80; 95% CI = −18.71 to 5.11) between the groups. Among the secondary outcomes, significant differences were observed in diaphragm thickness, fraction of inspired oxygen, partial pressure of oxygen/fraction of inspired oxygen ratio, C-reactive protein levels, lymphocyte count, and hemoglobin (p < 0.05). Conclusion Among severe COVID-19 patients requiring invasive mechanical ventilation, the length of ICU stay was not significantly different between the PBMT-sMF and placebo groups. In contrast, PBMT-sMF was significantly associated with reduced diaphragm atrophy, improved ventilatory parameters and lymphocyte count, and decreased C-reactive protein levels and hemoglobin count. Trial Registration Number (Clinical Trials.gov) NCT04386694.
Collapse
Affiliation(s)
- Thiago De Marchi
- University Center of Bento Gonçalves (UNICNEC), Bento Gonçalves, Rio Grande do Sul, Brazil.,Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Post-graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Fabiano Frâncio
- University Center of Bento Gonçalves (UNICNEC), Bento Gonçalves, Rio Grande do Sul, Brazil.,Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul, Brazil
| | | | - Renata Weigert
- Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul, Brazil
| | | | - Ana Paula Merlo
- Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul, Brazil
| | | | | | | | - Shaiane Silva Tomazoni
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,ELJ Consultancy, Scientific Consultants, São Paulo, Brazil
| | - Ernesto Cesar Leal-Junior
- Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Post-graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil.,Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,ELJ Consultancy, Scientific Consultants, São Paulo, Brazil
| |
Collapse
|
4
|
Cabrita B, Dias S, Fernandes AL, Correia S, Ferreira J, Simão P. Inspiratory muscle training in neuromuscular patients: Assessing the benefits of a novel protocol. J Back Musculoskelet Rehabil 2021; 34:537-543. [PMID: 33523039 DOI: 10.3233/bmr-200141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Neuromuscular diseases are characterized by the compromise of respiratory muscles, thoracic ventilation, muscle strength and coughing capacity. Patients have low quality of life and increased morbidity and mortality mostly due to respiratory impairment. OBJECTIVE To assess the benefits of adding inspiratory muscle training to neuromuscular patients' treatment and their compliance to the approach. METHODS We conducted a single-center prospective study with neuromuscular patients with decreased maximal inspiratory pressure. We developed an inspiratory muscle training protocol with three-month duration and once-daily training. The protocol had a progressive intensity that was individually tailored based on patients' baseline characteristics and tolerance. We used Powerbreathe Medic Classic devices to perform the training. RESULTS There were 21 patients who met the inclusion criteria and were enrolled in the study. Muscular dystrophy (n= 12, 57.3%) and amyotrophic lateral sclerosis (n= 4, 19%) were the most common diseases. After three months of training, patients increased their maximal inspiratory muscle pressure (p= 0.002) and peak cough flow (p= 0.011). Compliance to the protocol was 99 ± 5.5%. CONCLUSIONS This protocol showed significant improvements on pulmonary muscles function and might be considered as an adjunct treatment to neuromuscular treatment. However, these positive results require larger further studies to validate the clinical benefits long-term.
Collapse
|
5
|
De Marchi T, Frâncio F, Ferlito JV, Weigert R, de Oliveira C, Merlo AP, Pandini DL, Pasqual-Júnior BA, Giovanella D, Tomazoni SS, Leal-Junior EC. Effects of Photobiomodulation Therapy Combined with Static Magnetic Field in Severe COVID-19 Patients Requiring Intubation: A Pragmatic Randomized Placebo-Controlled Trial. J Inflamm Res 2021; 14:3569-3585. [PMID: 34335043 DOI: 10.1101/2020.12.02.20237974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/10/2021] [Indexed: 05/28/2023] Open
Abstract
PURPOSE We aimed to investigate the effects of photobiomodulation therapy combined with static magnetic field (PBMT-sMF) on the length of intensive care unit (ICU) stay and mortality rate of severe COVID-19 patients requiring invasive mechanical ventilation and assess its role in preserving respiratory muscles and modulating inflammatory processes. PATIENTS AND METHODS We conducted a prospectively registered, triple-blinded, randomized, placebo-controlled trial of PBMT-sMF in severe COVID-19 ICU patients requiring invasive mechanical ventilation. Patients were randomly assigned to receive either PBMT-sMF or a placebo daily throughout their ICU stay. The primary outcome was length of ICU stay, defined by either discharge or death. The secondary outcomes were survival rate, diaphragm muscle function, and the changes in blood parameters, ventilatory parameters, and arterial blood gases. RESULTS Thirty patients were included and equally randomized into the two groups. There were no significant differences in the length of ICU stay (mean difference, MD = -6.80; 95% CI = -18.71 to 5.11) between the groups. Among the secondary outcomes, significant differences were observed in diaphragm thickness, fraction of inspired oxygen, partial pressure of oxygen/fraction of inspired oxygen ratio, C-reactive protein levels, lymphocyte count, and hemoglobin (p < 0.05). CONCLUSION Among severe COVID-19 patients requiring invasive mechanical ventilation, the length of ICU stay was not significantly different between the PBMT-sMF and placebo groups. In contrast, PBMT-sMF was significantly associated with reduced diaphragm atrophy, improved ventilatory parameters and lymphocyte count, and decreased C-reactive protein levels and hemoglobin count. TRIAL REGISTRATION NUMBER CLINICAL TRIALSGOV NCT04386694.
Collapse
Affiliation(s)
- Thiago De Marchi
- University Center of Bento Gonçalves (UNICNEC), Bento Gonçalves, Rio Grande do Sul, Brazil
- Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Post-graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Fabiano Frâncio
- University Center of Bento Gonçalves (UNICNEC), Bento Gonçalves, Rio Grande do Sul, Brazil
- Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul, Brazil
| | | | - Renata Weigert
- Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul, Brazil
| | | | - Ana Paula Merlo
- Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul, Brazil
| | | | | | | | - Shaiane Silva Tomazoni
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- ELJ Consultancy, Scientific Consultants, São Paulo, Brazil
| | - Ernesto Cesar Leal-Junior
- Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Post-graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- ELJ Consultancy, Scientific Consultants, São Paulo, Brazil
| |
Collapse
|
6
|
Sandoval-Moreno LM, Forero-Anaya B, Giraldo-Medina S, Guiral-Campo JA, Betancourt-Peña J. Cambios fisiológicos relacionados con entrenamiento muscular respiratorio en pacientes con ventilación mecánica. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n3.75274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. El entrenamiento muscular respiratorio es una técnica fisioterapéutica usada para incrementar la fuerza de la musculatura respiratoria, sin embargo pocos estudios han abordado los cambios fisiológicos relacionados con esta intervención en pacientes con ventilación mecánica.Objetivo. Determinar los cambios fisiológicos relacionados con el entrenamiento muscular respiratorio en pacientes con ventilación mecánica.Materiales y métodos. Se realizó un análisis de datos secundarios en el marco del estudio “Eficacia del entrenamiento muscular respiratorio en el destete de la ventilación mecánica en pacientes con ventilación mecánica por 48 horas o más: Un ensayo clínico controlado”. La población estuvo conformada por los 62 pacientes del grupo experimental del estudio principal, quienes recibieron entrenamiento muscular respiratorio. Los valores de frecuencia cardiaca, frecuencia respiratoria, presión arterial, saturación de oxígeno y volumen corriente fueron registrados. La diferencia entre el promedio de cada una de las variables fue analizada mediante la prueba de t pareada, mientras que para el análisis de los cambios fisiológicos entre sesiones de entrenamiento se empleó la prueba de Kruskal-Wallis.Resultados. Se observaron diferencias significativas entre las variables fisiológicas antes y después del entrenamiento muscular respiratorio (p<0.05), a excepción del volumen corriente y la presión arterial media (p>0.05). Por el contrario, no se observaron diferencias significativas en ninguna de las variables fisiológicas entre sesiones de entrenamiento (p>0.05)Conclusiones. El entrenamiento muscular respiratorio es una intervención terapéutica viable y tolerable en esta población.
Collapse
|
7
|
Physical Activity Intolerance and Cardiorespiratory Dysfunction in Patients with Moderate-to-Severe Traumatic Brain Injury. Sports Med 2020; 49:1183-1198. [PMID: 31098990 DOI: 10.1007/s40279-019-01122-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Moderate-to-severe traumatic brain injury (TBI) is a chronic health condition with multi-systemic effects. Survivors face significant long-term functional limitations, including physical activity intolerance and disordered sleep. Persistent cardiorespiratory dysfunction is a potentially modifiable yet often overlooked major contributor to the alarmingly high long-term morbidity and mortality rates in these patients. This narrative review was developed through systematic and non-systematic searches for research relating cardiorespiratory function to moderate-to-severe TBI. The literature reveals patients who have survived moderate-to-severe TBI have ~ 25-35% reduction in maximal aerobic capacity 6-18 months post-injury, resting pulmonary capacity parameters that are reduced 25-40% for weeks to years post-injury, increased sedentary behavior, and elevated risk of cardiorespiratory-related morbidity and mortality. Synthesis of data from other patient populations reveals that cardiorespiratory dysfunction is likely a consequence of ventilator-induced diaphragmatic dysfunction (VIDD), which is not currently addressed in TBI management. Thus, cardiopulmonary exercise testing should be routinely performed in this patient population and those with cardiorespiratory deficits should be further evaluated for diaphragmatic dysfunction. Lack of targeted treatment for underlying cardiorespiratory dysfunction, including VIDD, likely contributes to physical activity intolerance and poor functional outcomes in these patients. Interventional studies have demonstrated that short-term exercise training programs are effective in patients with moderate-to-severe TBI, though improvement is variable. Inspiratory muscle training is beneficial in other patient populations with diaphragmatic dysfunction, and may be valuable for patients with TBI who have been mechanically ventilated. Thus, clinicians with expertise in cardiorespiratory fitness assessment and exercise training interventions should be included in patient management for individuals with moderate-to-severe TBI.
Collapse
|
8
|
McDonald T, Stiller K. Inspiratory muscle training is feasible and safe for patients with acute spinal cord injury. J Spinal Cord Med 2019; 42:220-227. [PMID: 29400990 PMCID: PMC6419641 DOI: 10.1080/10790268.2018.1432307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and safety and, to a lesser extent efficacy, of inspiratory muscle training (IMT) for patients with acute complete cervical or thoracic spinal cord injury (SCI). DESIGN Prospective, observational pilot study comprising a series of case reports. SETTING Tertiary care, public hospital. PARTICIPANTS Seven adult subjects with an acute complete cervical or thoracic SCI. INTERVENTIONS Participants received IMT as soon as their respiratory condition was stable. A high-resistance, low-repetition program of IMT using a POWERbreathe KH1 device was instituted. Training comprised 3-6 sets of 6 breaths, commenced at 50% maximum inspiratory pressure with the training load progressively increased. OUTCOME MEASURES Feasibility (number of sessions when the criteria to participate in IMT were met/not met), safety (symptoms and physiological stability) before, during and after IMT sessions and efficacy (lung function) were measured. RESULTS There were 50 sessions in total where participants met the criteria to receive IMT, with a mean (range) of 7.1 (3-11) IMT sessions per participant delivered over 10.7 (4-17) days. IMT was feasible, with all 50 planned sessions of IMT able to be delivered, and safe, with stable physiological parameters and no adverse symptoms or events recorded before, during or after IMT. Maximal inspiratory pressure increased for four participants and forced vital capacity increased for three participants over the duration of their IMT sessions. CONCLUSION A high-resistance, low-repetition program of IMT was feasible and safe in adults with an acute complete cervical or thoracic SCI whose respiratory status was stable. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN 12614000975695).
Collapse
Affiliation(s)
- Tony McDonald
- Physiotherapy Department, Royal Adelaide Hospital, Adelaide, Australia,Correspondence to: Tony McDonald, 5G-183 Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia5000. Ph: 61 8 70740000.
| | - Kathy Stiller
- Allied Health, Central Adelaide Local Health Network, Adelaide, Australia
| |
Collapse
|
9
|
Sadek Z, Salami A, Joumaa WH, Awada C, Ahmaidi S, Ramadan W. Best mode of inspiratory muscle training in heart failure patients: a systematic review and meta-analysis. Eur J Prev Cardiol 2018; 25:1691-1701. [PMID: 30073849 DOI: 10.1177/2047487318792315] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives The objective of this study was to evaluate the effects of inspiratory muscle training on inspiratory muscle strength, functional capacity and dyspnoea for patients with chronic heart failure, by summarising the published research on the effects of inspiratory muscle training. To identify the best mode of intervention in terms of: the load of maximal inspiratory pressure; the frequency of sessions; and the total duration of intervention. Methods A relevant literature research using the PubMed database, Cochrane and references of published studies, from 1998 to 2016, was conducted. Out of 65 randomised controlled trials, seven were considered as potentially relevant and were retrieved for detailed analysis. The methodological quality of each randomised controlled trial was rated using the physiotherapy evidence database scale. Results The included seven studies contained data on 203 patients. Typical training protocols involved training three, six or seven times per week with intensity ranging from 30% to 60% and for a duration ranging from 6 to 12 weeks. Maximal inspiratory pressure, walking distance and dyspnoea were improved in all studies and especially in those who set a load of 60% in their maximal inspiratory pressure, and have trained patients six times per week for 12 weeks. Conclusion In chronic heart failure patients, inspiratory muscle training results in a marked improvement in inspiratory muscle strength, walking distance and dyspnoea, notably when training patients at 60% of maximal inspiratory pressure, six times per week and for 12 weeks. A small number of studies and heterogeneity among studies may limit the findings of the present study.
Collapse
Affiliation(s)
- Zahra Sadek
- 1 Rammal Hassan Rammal Research Laboratory, Physio-toxicity (PhyTox), Lebanese University, Faculty of Sciences, Nabatieh, Lebanon.,2 Laboratory EA-3300: APERE. Adaptations Physiologiques à l'Exercice et Réadaptation à l'Effort. Picardie Jules Verne University, Amiens, F-80025, France
| | - Ali Salami
- 1 Rammal Hassan Rammal Research Laboratory, Physio-toxicity (PhyTox), Lebanese University, Faculty of Sciences, Nabatieh, Lebanon
| | - Wissam H Joumaa
- 1 Rammal Hassan Rammal Research Laboratory, Physio-toxicity (PhyTox), Lebanese University, Faculty of Sciences, Nabatieh, Lebanon
| | - Charifa Awada
- 1 Rammal Hassan Rammal Research Laboratory, Physio-toxicity (PhyTox), Lebanese University, Faculty of Sciences, Nabatieh, Lebanon
| | - Said Ahmaidi
- 2 Laboratory EA-3300: APERE. Adaptations Physiologiques à l'Exercice et Réadaptation à l'Effort. Picardie Jules Verne University, Amiens, F-80025, France
| | - Wiam Ramadan
- 1 Rammal Hassan Rammal Research Laboratory, Physio-toxicity (PhyTox), Lebanese University, Faculty of Sciences, Nabatieh, Lebanon.,3 Lebanese Institutes for Biomedical Research and Application (LIBRA), Lebanese International University, Lebanon
| |
Collapse
|
10
|
Bissett B, Leditschke IA, Green M, Marzano V, Collins S, Van Haren F. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care 2018; 32:249-255. [PMID: 30007823 DOI: 10.1016/j.aucc.2018.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU). BACKGROUND Inspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients. METHODS Patients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set. RESULTS Using this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days' duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT. CONCLUSIONS This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.
Collapse
Affiliation(s)
- Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Canberra Hospital, Canberra, Australia; Physiotherapy Department, Canberra Hospital, Canberra, Australia.
| | - I Anne Leditschke
- Intensive Care Unit, Mater Health, Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Margot Green
- Physiotherapy Department, Canberra Hospital, Canberra, Australia
| | - Vince Marzano
- Physiotherapy Department, Canberra Hospital, Canberra, Australia
| | | | - Frank Van Haren
- Intensive Care Unit, Canberra Hospital, Canberra, Australia; School of Medicine, Australian National University, Canberra, Australia; Faculty of Health, University of Canberra, Canberra, Australia
| |
Collapse
|
11
|
Human A, Corten L, Jelsma J, Morrow B. Inspiratory muscle training for children and adolescents with neuromuscular diseases: A systematic review. Neuromuscul Disord 2017; 27:503-517. [PMID: 28462787 DOI: 10.1016/j.nmd.2017.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 01/24/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
Patients with neuromuscular diseases are at risk of morbidity and mortality due to respiratory compromise caused by respiratory muscle weakness. A systematic review was performed using pre-specified search strategies to determine the safety of inspiratory muscle training (IMT) and whether it has an impact on inspiratory muscle strength and endurance, exercise capacity, pulmonary function, dyspnoea and health-related quality of life. Randomised, quasi-randomised, cross-over and clinical controlled trials were included if they assessed the use of an external IMT device compared to no, sham/placebo, or alternative IMT treatment in children aged 5-18 years with neuromuscular diseases. Seven full-text articles and two on-going trials (n = 168) were included. Most studies used threshold IMT devices over a medium to long-term period, and none reported any adverse events. Studies differed regarding intensity, repetitions, frequency, rest intervals and duration of IMT. Six studies reported no significant improvement in pulmonary function tests following IMT. Two comparable studies reported significant improvement in inspiratory muscle endurance and four studies reported significantly greater improvement in inspiratory muscle strength in experimental groups. The latter was confirmed in a meta-analysis of two comparable studies (overall effect p < 0.00001). Other outcome measures could not be pooled. There is currently insufficient evidence to guide clinical IMT practice, owing to the limited number of included studies; small sample sizes; data heterogeneity; and risk of bias amongst included studies. Large sample randomised controlled trials are needed to determine safety and efficacy of IMT in paediatric and adolescent patients with neuromuscular diseases.
Collapse
Affiliation(s)
- Anri Human
- School of Health Care Sciences (Physiotherapy Department), Sefako Makgatho Health Sciences University, Garankuwa, South Africa; Health and Rehabilitation Sciences (Division of Physiotherapy), University of Cape Town, Observatory, South Africa.
| | - Lieselotte Corten
- Health and Rehabilitation Sciences (Division of Physiotherapy), University of Cape Town, Observatory, South Africa
| | - Jennifer Jelsma
- Health and Rehabilitation Sciences (Division of Physiotherapy), University of Cape Town, Observatory, South Africa
| | - Brenda Morrow
- Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa
| |
Collapse
|
12
|
Volpe MS, Aleixo AA, Almeida PRMND. Influence of inspiratory muscle training on weaning patients from mechanical ventilation: a systematic review. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/0103-5150.029.001.ar02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The inability of respiratory muscles to generate force and endurance is recognized as an important cause of failure in weaning patients from invasive mechanical ventilation (IMV). Thus, inspiratory muscle training (IMT) might be an interesting treatment option for patients with prolonged IMV weaning. Objective: The aim of this systematic literature review was to evaluate the effectiveness of inspiratory muscle training in weaning patients from mechanical ventilation and to identify the most effective type of training for this particular purpose. Methods: We searched PubMed, LILACS, PEDro and Web of Science for randomized clinical trials published in English or Portuguese from January 1990 until March 2015. Results: Eighty-nine studies were identified of which five were selected. A total of 267 patients participated in the five randomized clinical trials analyzed here. IMV duration before onset of training varied greatly among subjects. Three studies performed IMT using a threshold device and two studies used adjustments of ventilator pressure sensitivity. Four studies have shown that IMT resulted in a significant increase in inspiratory maximal pressure. Only two studies, however, have reported that IMT resulted in higher success rates in weaning patients from IMV. One study has found that patients showed a shorter ventilator weaning duration after IMT. Conclusion: IMT using pressure threshold devices results in increased inspiratory muscle strength and can therefore be considered a more effective treatment option and with the potential to optimize ventilator weaning success in patients at risk of prolonged IMV.
Collapse
|
13
|
Bissett B, Leditschke IA, Neeman T, Boots R, Paratz J. 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; 44:15-20. [DOI: 10.1016/j.hrtlng.2014.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 11/17/2022]
|
14
|
Bruchim Y, Aroch I, Sisso A, Kushnir Y, Epstein A, Kelmer E, Segev G. A retrospective study of positive pressure ventilation in 58 dogs: indications, prognostic factors and outcome. J Small Anim Pract 2014; 55:314-9. [DOI: 10.1111/jsap.12211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Y. Bruchim
- Koret School of Veterinary Medicine; Veterinary Teaching Hospital; The Hebrew University of Jerusalem; Rehovot 76100 Israel
| | - I. Aroch
- Koret School of Veterinary Medicine; Veterinary Teaching Hospital; The Hebrew University of Jerusalem; Rehovot 76100 Israel
| | - A. Sisso
- Koret School of Veterinary Medicine; Veterinary Teaching Hospital; The Hebrew University of Jerusalem; Rehovot 76100 Israel
| | - Y. Kushnir
- Koret School of Veterinary Medicine; Veterinary Teaching Hospital; The Hebrew University of Jerusalem; Rehovot 76100 Israel
| | - A. Epstein
- Koret School of Veterinary Medicine; Veterinary Teaching Hospital; The Hebrew University of Jerusalem; Rehovot 76100 Israel
| | - E. Kelmer
- Koret School of Veterinary Medicine; Veterinary Teaching Hospital; The Hebrew University of Jerusalem; Rehovot 76100 Israel
| | - G. Segev
- Koret School of Veterinary Medicine; Veterinary Teaching Hospital; The Hebrew University of Jerusalem; Rehovot 76100 Israel
| |
Collapse
|
15
|
Baldwin MR, Narain WR, Wunsch H, Schluger NW, Cooke JT, Maurer MS, Rowe JW, Lederer DJ, Bach PB. A prognostic model for 6-month mortality in elderly survivors of critical illness. Chest 2013; 143:910-919. [PMID: 23632902 DOI: 10.1378/chest.12-1668] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although 1.4 million elderly Americans survive hospitalization involving intensive care annually, many are at risk for early mortality following discharge. No models that predict the likelihood of death after discharge exist explicitly for this population. Therefore, we derived and externally validated a 6-month postdischarge mortality prediction model for elderly ICU survivors. METHODS We derived the model from medical record and claims data for 1,526 consecutive patients aged ≥ 65 years who had their first medical ICU admission in 2006 to 2009 at a tertiary-care hospital and survived to discharge (excluding those patients discharged to hospice). We then validated the model in 1,010 patients from a different tertiary-care hospital. RESULTS Six-month mortality was 27.3% and 30.2% in the derivation and validation cohorts, respectively. Independent predictors of mortality (in descending order of contribution to the model's predictive power) were a do-not-resuscitate order, older age, burden of comorbidity, admission from or discharge to a skilled-care facility, hospital length of stay, principal diagnoses of sepsis and hematologic malignancy, and male sex. For the derivation and external validation cohorts, the area under the receiver operating characteristic curve was 0.80 (SE, 0.01) and 0.71 (SE, 0.02), respectively, with good calibration for both (P = 0.31 and 0.43). CONCLUSIONS Clinical variables available at hospital discharge can help predict 6-month mortality for elderly ICU survivors. Variables that capture elements of frailty, disability, the burden of comorbidity, and patient preferences regarding resuscitation during the hospitalization contribute most to this model's predictive power. The model could aid providers in counseling elderly ICU survivors at high risk of death and their families.
Collapse
Affiliation(s)
- Matthew R Baldwin
- Division of Pulmonary, Allergy, and Critical Care, Columbia University, New York, NY.
| | - Wazim R Narain
- Data Analytics Group, New York-Presbyterian Hospital, New York, NY
| | - Hannah Wunsch
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, New York, NY
| | - Neil W Schluger
- Division of Pulmonary, Allergy, and Critical Care, Columbia University, New York, NY; Department of Epidemiology, New York, NY
| | - Joseph T Cooke
- Division of Pulmonary and Critical Care, Weill Cornell Medical College, New York, NY
| | - Mathew S Maurer
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - John W Rowe
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY
| | - David J Lederer
- Division of Pulmonary, Allergy, and Critical Care, Columbia University, New York, NY; Department of Epidemiology, New York, NY
| | - Peter B Bach
- Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center, New York, NY
| |
Collapse
|
16
|
Bissett BM, Leditschke IA, Paratz JD, Boots RJ. Protocol: inspiratory muscle training for promoting recovery and outcomes in ventilated patients (IMPROVe): a randomised controlled trial. BMJ Open 2012; 2:e000813. [PMID: 22389363 PMCID: PMC3293141 DOI: 10.1136/bmjopen-2012-000813] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Inspiratory muscle weakness is a known consequence of mechanical ventilation and a potential contributor to difficulty in weaning from ventilatory support. Inspiratory muscle training (IMT) reduces the weaning period and increases the likelihood of successful weaning in some patients. However, it is not known how this training affects the residual inspiratory muscle fatigability following successful weaning nor patients' quality of life or functional outcomes. METHODS AND ANALYSIS This dual centre study includes two concurrent randomised controlled trials of IMT in adult patients who are either currently ventilator-dependent (>7 days) (n=70) or have been recently weaned from mechanical ventilation (>7 days) in the past week (n=70). Subjects will be stable, alert and able to actively participate and provide consent. There will be concealed allocation to either treatment (IMT) or usual physiotherapy (including deep breathing exercises without a resistance device). Primary outcomes are inspiratory muscle fatigue resistance and maximum inspiratory pressures. Secondary outcomes are quality of life (Short Form-36v2, EQ-5D), functional status (Acute Care Index of Function), rate of perceived exertion (Borg Scale), intensive care length of stay (days), post intensive care length of stay (days), rate of reintubation (%) and duration of ventilation (days). ETHICS AND DISSEMINATION Ethics approval has been obtained from relevant institutions, and results will be published with a view to influencing physiotherapy practice in the management of long-term ventilator-dependent patients to accelerate weaning and optimise rehabilitation outcomes. TRIAL REGISTRATION NUMBER ACTRN12610001089022.
Collapse
Affiliation(s)
- Bernie M Bissett
- Physiotherapy Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - I Anne Leditschke
- Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- School of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jennifer D Paratz
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Burns, Trauma & Critical Care Research Centre, University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Robert J Boots
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Burns, Trauma & Critical Care Research Centre, University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| |
Collapse
|