title: Inspiratory muscle training to enhance recovery from mechanical ventilation: a randomised trial.
abstract: In patients who have been mechanically ventilated, inspiratory muscles remain weak and fatigable following ventilatory weaning, which may contribute to dyspnoea and limited functional recovery. Inspiratory muscle training may improve inspiratory muscle strength and endurance following weaning, potentially improving dyspnoea and quality of life in this patient group.
  
  
  
  We conducted a randomised trial with assessor-blinding and intention-to-treat analysis. Following 48 hours of successful weaning, 70 participants (mechanically ventilated ≥7 days) were randomised to receive inspiratory muscle training once daily 5 days/week for 2 weeks in addition to usual care, or usual care (control). Primary endpoints were inspiratory muscle strength and fatigue resistance index (FRI) 2 weeks following enrolment. Secondary endpoints included dyspnoea, physical function and quality of life, post-intensive care length of stay and in-hospital mortality.
  
  
  
  34 participants were randomly allocated to the training group and 36 to control. The training group demonstrated greater improvements in inspiratory strength (training: 17%, control: 6%, mean difference: 11%, p=0.02). There were no statistically significant differences in FRI (0.03 vs 0.02, p=0.81), physical function (0.25 vs 0.25, p=0.97) or dyspnoea (-0.5 vs 0.2, p=0.22). Improvement in quality of life was greater in the training group (14% vs 2%, mean difference 12%, p=0.03). In-hospital mortality was higher in the training group (4 vs 0, 12% vs 0%, p=0.051).
  
  
  
  Inspiratory muscle training following successful weaning increases inspiratory muscle strength and quality of life, but we cannot confidently rule out an associated increased risk of in-hospital mortality.
  
  
  
  ACTRN12610001089022, results.
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Queensland, Australia Discipline of Physiotherapy, University of Canberra, Australia Physiotherapy Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
authors.forename: Bernie M
authors.initials: BM
authors.lastname: Bissett
authors.affiliation: Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia Intensive Care Unit, Mater Hospital, Brisbane, Queensland, Australia School of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: I Anne
authors.initials: IA
authors.lastname: Leditschke
authors.affiliation: Statistical Consulting Unit, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Teresa
authors.initials: T
authors.lastname: Neeman
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Queensland, Australia Intensive Care Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Boots
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Queensland, Australia Intensive Care Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia School of Alllied Health Sciences, Griffith University, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Paratz
mesh_terms: D000328:Adult; D000368:Aged; D001945:Breathing Exercises / Q000379:methods*; D004417:Dyspnea / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D001239:Inhalation / Q000502:physiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012132:Respiratory Muscles / Q000503:physiopathology*; D012138:Respiratory Therapy / Q000379:methods; D016037:Single-Blind Method; D015300:Ventilator Weaning / Q000379:methods
keywords: Exercise; Respiratory Measurement; Respiratory Muscles