Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial.
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.
Cader
Samária Ali
SA
University Federal do Estada do Rio de Janiero - LABIMH-UNIRIO, Brazil. samariacader@gmail.com
Vale
Rodrigo Gomes de Souza
RG
Castro
Juracy Correa
JC
Bacelar
Silvia Corrêa
SC
Biehl
Cintia
C
Gomes
Maria Celeste Vega
MC
Cabrer
Walter Eduardo
WE
Dantas
Estélio Henrique Martin
EH
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