title: Inspiratory muscle training is used in some intensive care units, but many training methods have uncertain efficacy: a survey of French physiotherapists.
abstract: OBJECTIVE
  How common is inspiratory muscle training by physiotherapists in the intensive care unit (ICU)? Which patients receive the training? What methods are used to administer the training? Is maximal inspiratory pressure used to evaluate the need for the training and the patient's outcome after training?
  
  
  METHODS
  Cross-sectional survey of all ICUs in France.
  
  
  METHODS
  Two hundred and sixty-five senior physiotherapists.
  
  
  RESULTS
  The response rate was 99% among eligible units. Therapist experience in ICU was significantly associated with the use of inspiratory muscle training (p=0.02). Therapists mainly used inspiratory muscle training either systematically or specifically in patients who failed to wean from mechanical ventilation. The training was used significantly more in non-sedated patients (p<0.0001). The most commonly nominated technique that respondents claimed to use to apply the training was controlled diaphragmatic breathing (83% of respondents), whereas 13% used evidence-based methods. Among those who applied some form of inspiratory muscle training, 16% assessed maximal inspiratory pressure. Six respondents (2%, 95% CI 1 to 5) used both an evidence-based method to administer inspiratory muscle training and the recommended technique for assessment of inspiratory muscle strength.
  
  
  CONCLUSIONS
  Most physiotherapists in French ICUs who apply inspiratory muscle training use methods of uncertain efficacy without assessment of maximal inspiratory pressure. Further efforts need to be made in France to disseminate information regarding evidence-based assessment and techniques for inspiratory muscle training in the ICU. The alignment of inspiratory muscle training practice with evidence could be investigated in other regions.
authors.affiliation: ADIR Association, Bois-Guillaume; Service de réanimation chirurgicale; Université de Picardie Jules Verne, Amiens.
authors.forename: Tristan
authors.initials: T
authors.lastname: Bonnevie
authors.affiliation: Université Joseph Fourier, Grenoble.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Villiot-Danger
authors.affiliation: ADIR Association, Bois-Guillaume; Service réanimation médicale, CHU-Hôpitaux de Rouen, Rouen.
authors.forename: Francis-Edouard
authors.initials: FE
authors.lastname: Gravier
authors.affiliation: ADIR Assistance, Isneauville.
authors.forename: Johan
authors.initials: J
authors.lastname: Dupuis
authors.affiliation: Université de Picardie Jules Verne, Amiens; Service de réanimation médico-chirurgicale, Groupe hospitalier du Havre, Montivilliers, France.
authors.forename: Guillame
authors.initials: G
authors.lastname: Prieur
authors.affiliation: Université de Picardie Jules Verne, Amiens; Service de réanimation médico-chirurgicale, Groupe hospitalier du Havre, Montivilliers, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Médrinal
mesh_terms: D001945:Breathing Exercises / Q000379:methods*; D003430:Cross-Sectional Studies; D005081:Exercise Therapy / Q000379:methods*; D005602:France; D019538:Health Care Surveys; D006801:Humans; D007320:Inspiratory Capacity; D007362:Intensive Care Units; D053580:Muscle Strength / Q000502:physiology; D059825:Physical Therapists; D012121:Respiration, Artificial; D012132:Respiratory Muscles / Q000502:physiology*; D016896:Treatment Outcome
keywords: Intensive care; Mechanical ventilators; Physiotherapy; Respiratory muscle training; Survey