title: Extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training: a randomized clinical trial.
abstract: BACKGROUND
  The purpose of this study was to evaluate the extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training (IMT) and identify predictors of successful weaning.
  
  
  METHODS
  Twenty-eight elderly intubated patients in an intensive care unit were randomly assigned to an experimental group (n = 14) that received conventional physiotherapy plus IMT with a Threshold IMT(®) device or to a control group (n = 14) that received only conventional physiotherapy. The experimental protocol for muscle training consisted of an initial load of 30% maximum inspiratory pressure, which was increased by 10% daily. The training was administered for 5 minutes, twice daily, 7 days a week, with supplemental oxygen from the beginning of weaning until extubation. Successful extubation was defined by the ventilation time measurement with noninvasive positive pressure. A vacuum manometer was used for measurement of maximum inspiratory pressure, and the patients' Tobin index values were measured using a ventilometer.
  
  
  RESULTS
  The maximum inspiratory pressure increased significantly (by 7 cm H(2)O, 95% confidence interval [CI] 4-10), and the Tobin index decreased significantly (by 16 breaths/ min/L, 95% CI -26 to 6) in the experimental group compared with the control group. The Chi-squared distribution did not indicate a significant difference in weaning success between the groups (χ(2) = 1.47; P = 0.20). However, a comparison of noninvasive positive pressure time dependence indicated a significantly lower value for the experimental group (P = 0.0001; 95% CI 13.08-18.06). The receiver-operating characteristic curve showed an area beneath the curve of 0.877 ± 0.06 for the Tobin index and 0.845 ± 0.07 for maximum inspiratory pressure.
  
  
  CONCLUSIONS
  The IMT intervention significantly increased maximum inspiratory pressure and significantly reduced the Tobin index; both measures are considered to be good extubation indices. IMT was associated with a reduction in noninvasive positive pressure time in the experimental group.
authors.affiliation: Laboratory of Human Kinetics Bioscience, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil. samariacader@gmail.com
authors.forename: Samária Ali
authors.initials: SA
authors.lastname: Cader
authors.forename: Rodrigo Gomes
authors.initials: RG
authors.lastname: de Souza Vale
authors.forename: Victor Emmanuel
authors.initials: VE
authors.lastname: Zamora
authors.forename: Claudia Henrique
authors.initials: CH
authors.lastname: Costa
authors.forename: Estélio Henrique Martin
authors.initials: EH
authors.lastname: Dantas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation / Q000379:methods*; D001945:Breathing Exercises; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D012129:Respiratory Function Tests
keywords: extubation; inspiratory muscle training; rehabilitation