title: Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial.
abstract: OBJECTIVE
  Does inspiratory muscle training improve maximal inspiratory pressure in intubated older people? Does it improve breathing pattern and time to wean from mechanical ventilation?
  
  
  METHODS
  Randomised trial with concealed allocation and intention-to-treat analysis.
  
  
  METHODS
  41 elderly, intubated adults who had been mechanically ventilated for at least 48 hr in an intensive care unit.
  
  
  METHODS
  The experimental group received usual care plus inspiratory muscle training using a threshold device, with an initial load of 30% of their maximal inspiratory pressure, increased by 10% (absolute) daily. Training was administered for 5 min, twice a day, 7 days a week from the commencement of weaning until extubation. The control group received usual care only.
  
  
  METHODS
  The primary outcome was the change in maximal inspiratory pressure during the weaning period. Secondary outcomes were the weaning time (ie, from commencement of pressure support ventilation to successful extubation), and the index of Tobin (ie, respiratory rate divided by tidal volume during a 1-min spontaneous breathing trial).
  
  
  RESULTS
  Maximal inspiratory pressure increased significantly more in the experimental group than in the control group (MD 7.6 cmH(2)0, 95% CI 5.8 to 9.4). The index of Tobin decreased significantly more in the experimental group than in the control group (MD 8.3 br/min/L, 95% CI 2.9 to 13.7). In those who did not die or receive a tracheostomy, time to weaning was significantly shorter in the experimental group than in the control group (MD 1.7 days, 95% CI 0.4 to 3.0).
  
  
  CONCLUSIONS
  In intubated older people, inspiratory muscle training improves maximal inspiratory pressure and the index of Tobin, with a reduced weaning time in some patients.
  
  
  BACKGROUND
  NCT00922493.
authors.affiliation: University Federal do Estada do Rio de Janiero - LABIMH-UNIRIO, Brazil. samariacader@gmail.com
authors.forename: Samária Ali
authors.initials: SA
authors.lastname: Cader
authors.forename: Rodrigo Gomes de Souza
authors.initials: RG
authors.lastname: Vale
authors.forename: Juracy Correa
authors.initials: JC
authors.lastname: Castro
authors.forename: Silvia Corrêa
authors.initials: SC
authors.lastname: Bacelar
authors.forename: Cintia
authors.initials: C
authors.lastname: Biehl
authors.forename: Maria Celeste Vega
authors.initials: MC
authors.lastname: Gomes
authors.forename: Walter Eduardo
authors.initials: WE
authors.lastname: Cabrer
authors.forename: Estélio Henrique Martin
authors.initials: EH
authors.lastname: Dantas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D001239:Inhalation / Q000502:physiology*; D007442:Intubation, Intratracheal; D053208:Kaplan-Meier Estimate; D008297:Male; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D012119:Respiration; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D012132:Respiratory Muscles / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning