Inspiratory Muscle Rehabilitation in Critically Ill Adults

A Systematic Review and Meta-Analysis

Stefannie Vorona, U Sabatini, S Al-Maqbali , M Bertoni, M Dres, Bernie BISSETT, Frank Van Haren, AD Martin, C Urrea, D Brace, M Parotto, MS Herridge, NK Adhikari, Eddy Fan, LT Melo, Reid WD, Laurent Brochard, ND Ferguson, Ewan Goligher

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Rationale: Respiratory muscle weakness is common in critically ill patients; the role of targeted inspiratory muscle training (IMT) in intensive care unit rehabilitation strategies remains poorly defined. Objectives: The primary objective of the present study was to describe the range and tolerability of published methods for IMT. The secondary objectives were to determine whether IMT improves respiratory muscle strength and clinical outcomes in critically ill patients. Methods: We conducted a systematic review to identify randomized and nonrandomized studies of physical rehabilitation interventions intended to strengthen the respiratory muscles in critically ill adults. We searched the MEDLINE, Embase, HealthSTAR, CINAHL, and CENTRAL databases (inception to September Week 3, 2017) and conference proceedings (2012 to 2017). Data were independently extracted by two authors and collected on a standardized report form. Results: A total of 28 studies (N = 1,185 patients) were included. IMT was initiated during early mechanical ventilation (8 studies), after patients proved difficult to wean (14 studies), or after extubation (3 studies), and 3 other studies did not report exact timing. Threshold loading was the most common technique; 13 studies employed strength training regimens, 11 studies employed endurance training regimens, and 4 could not be classified. IMT was feasible, and there were few adverse events during IMT sessions (nine studies; median, 0%; interquartile range, 0-0%). In randomized trials (n = 20), IMT improved maximal inspiratory pressure compared with control (15 trials; mean increase, 6 cm H 2 O; 95% confidence interval [CI], 5-8 cm H 2 O; pooled relative ratio of means, 1.19; 95% CI, 1.14-1.25) and maximal expiratory pressure (4 trials; mean increase, 9 cm H 2 O; 95% CI, 5-14 cm H 2 O). IMT was associated with a shorter duration of ventilation (nine trials; mean difference, 4.1 d; 95% CI, 0.8-7.4 d) and a shorter duration of weaning (eight trials; mean difference, 2.3 d; 95% CI, 0.7-4.0 d), but confidence in these pooled estimates was low owing to methodological limitations, including substantial statistical and methodological heterogeneity. Conclusions: Most studies of IMT in critically ill patients have employed inspiratory threshold loading. IMT is feasible and well tolerated in critically ill patients and improves both inspiratory and expiratory muscle strength. The impact of IMT on clinical outcomes requires future confirmation.

Original languageEnglish
Pages (from-to)735-744
Number of pages10
JournalAnnals of the American Thoracic Society
Volume15
Issue number6
DOIs
Publication statusPublished - 2018

Fingerprint

Critical Illness
Meta-Analysis
Rehabilitation
Muscles
Confidence Intervals
Respiratory Muscles
Muscle Strength
Breathing Exercises
Resistance Training
Muscle Weakness
Weaning
Artificial Respiration
MEDLINE
Intensive Care Units
Ventilation
Databases

Cite this

Vorona, Stefannie ; Sabatini, U ; Al-Maqbali , S ; Bertoni, M ; Dres, M ; BISSETT, Bernie ; Van Haren, Frank ; Martin, AD ; Urrea, C ; Brace, D ; Parotto, M ; Herridge, MS ; Adhikari, NK ; Fan, Eddy ; Melo, LT ; WD, Reid ; Brochard, Laurent ; Ferguson, ND ; Goligher, Ewan. / Inspiratory Muscle Rehabilitation in Critically Ill Adults : A Systematic Review and Meta-Analysis. In: Annals of the American Thoracic Society. 2018 ; Vol. 15, No. 6. pp. 735-744.
@article{98e0405b676a44d4b85478e900b061a0,
title = "Inspiratory Muscle Rehabilitation in Critically Ill Adults: A Systematic Review and Meta-Analysis",
abstract = "Rationale: Respiratory muscle weakness is common in critically ill patients; the role of targeted inspiratory muscle training (IMT) in intensive care unit rehabilitation strategies remains poorly defined. Objectives: The primary objective of the present study was to describe the range and tolerability of published methods for IMT. The secondary objectives were to determine whether IMT improves respiratory muscle strength and clinical outcomes in critically ill patients. Methods: We conducted a systematic review to identify randomized and nonrandomized studies of physical rehabilitation interventions intended to strengthen the respiratory muscles in critically ill adults. We searched the MEDLINE, Embase, HealthSTAR, CINAHL, and CENTRAL databases (inception to September Week 3, 2017) and conference proceedings (2012 to 2017). Data were independently extracted by two authors and collected on a standardized report form. Results: A total of 28 studies (N = 1,185 patients) were included. IMT was initiated during early mechanical ventilation (8 studies), after patients proved difficult to wean (14 studies), or after extubation (3 studies), and 3 other studies did not report exact timing. Threshold loading was the most common technique; 13 studies employed strength training regimens, 11 studies employed endurance training regimens, and 4 could not be classified. IMT was feasible, and there were few adverse events during IMT sessions (nine studies; median, 0{\%}; interquartile range, 0-0{\%}). In randomized trials (n = 20), IMT improved maximal inspiratory pressure compared with control (15 trials; mean increase, 6 cm H 2 O; 95{\%} confidence interval [CI], 5-8 cm H 2 O; pooled relative ratio of means, 1.19; 95{\%} CI, 1.14-1.25) and maximal expiratory pressure (4 trials; mean increase, 9 cm H 2 O; 95{\%} CI, 5-14 cm H 2 O). IMT was associated with a shorter duration of ventilation (nine trials; mean difference, 4.1 d; 95{\%} CI, 0.8-7.4 d) and a shorter duration of weaning (eight trials; mean difference, 2.3 d; 95{\%} CI, 0.7-4.0 d), but confidence in these pooled estimates was low owing to methodological limitations, including substantial statistical and methodological heterogeneity. Conclusions: Most studies of IMT in critically ill patients have employed inspiratory threshold loading. IMT is feasible and well tolerated in critically ill patients and improves both inspiratory and expiratory muscle strength. The impact of IMT on clinical outcomes requires future confirmation.",
keywords = "Artificial respiration, Inspiratory muscle training, Physical therapy, Respiratory muscles, Weaning",
author = "Stefannie Vorona and U Sabatini and S Al-Maqbali and M Bertoni and M Dres and Bernie BISSETT and {Van Haren}, Frank and AD Martin and C Urrea and D Brace and M Parotto and MS Herridge and NK Adhikari and Eddy Fan and LT Melo and Reid WD and Laurent Brochard and ND Ferguson and Ewan Goligher",
year = "2018",
doi = "10.1513/AnnalsATS.201712-961OC",
language = "English",
volume = "15",
pages = "735--744",
journal = "Proceedings of the American Thoracic Society",
issn = "1546-3222",
publisher = "American Thoracic Society",
number = "6",

}

Vorona, S, Sabatini, U, Al-Maqbali , S, Bertoni, M, Dres, M, BISSETT, B, Van Haren, F, Martin, AD, Urrea, C, Brace, D, Parotto, M, Herridge, MS, Adhikari, NK, Fan, E, Melo, LT, WD, R, Brochard, L, Ferguson, ND & Goligher, E 2018, 'Inspiratory Muscle Rehabilitation in Critically Ill Adults: A Systematic Review and Meta-Analysis', Annals of the American Thoracic Society, vol. 15, no. 6, pp. 735-744. https://doi.org/10.1513/AnnalsATS.201712-961OC

Inspiratory Muscle Rehabilitation in Critically Ill Adults : A Systematic Review and Meta-Analysis. / Vorona, Stefannie; Sabatini, U; Al-Maqbali , S; Bertoni, M; Dres, M; BISSETT, Bernie; Van Haren, Frank ; Martin, AD; Urrea, C; Brace, D; Parotto, M; Herridge, MS; Adhikari, NK; Fan, Eddy; Melo, LT; WD, Reid; Brochard, Laurent; Ferguson, ND; Goligher, Ewan.

In: Annals of the American Thoracic Society, Vol. 15, No. 6, 2018, p. 735-744.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Inspiratory Muscle Rehabilitation in Critically Ill Adults

T2 - A Systematic Review and Meta-Analysis

AU - Vorona, Stefannie

AU - Sabatini, U

AU - Al-Maqbali , S

AU - Bertoni, M

AU - Dres, M

AU - BISSETT, Bernie

AU - Van Haren, Frank

AU - Martin, AD

AU - Urrea, C

AU - Brace, D

AU - Parotto, M

AU - Herridge, MS

AU - Adhikari, NK

AU - Fan, Eddy

AU - Melo, LT

AU - WD, Reid

AU - Brochard, Laurent

AU - Ferguson, ND

AU - Goligher, Ewan

PY - 2018

Y1 - 2018

N2 - Rationale: Respiratory muscle weakness is common in critically ill patients; the role of targeted inspiratory muscle training (IMT) in intensive care unit rehabilitation strategies remains poorly defined. Objectives: The primary objective of the present study was to describe the range and tolerability of published methods for IMT. The secondary objectives were to determine whether IMT improves respiratory muscle strength and clinical outcomes in critically ill patients. Methods: We conducted a systematic review to identify randomized and nonrandomized studies of physical rehabilitation interventions intended to strengthen the respiratory muscles in critically ill adults. We searched the MEDLINE, Embase, HealthSTAR, CINAHL, and CENTRAL databases (inception to September Week 3, 2017) and conference proceedings (2012 to 2017). Data were independently extracted by two authors and collected on a standardized report form. Results: A total of 28 studies (N = 1,185 patients) were included. IMT was initiated during early mechanical ventilation (8 studies), after patients proved difficult to wean (14 studies), or after extubation (3 studies), and 3 other studies did not report exact timing. Threshold loading was the most common technique; 13 studies employed strength training regimens, 11 studies employed endurance training regimens, and 4 could not be classified. IMT was feasible, and there were few adverse events during IMT sessions (nine studies; median, 0%; interquartile range, 0-0%). In randomized trials (n = 20), IMT improved maximal inspiratory pressure compared with control (15 trials; mean increase, 6 cm H 2 O; 95% confidence interval [CI], 5-8 cm H 2 O; pooled relative ratio of means, 1.19; 95% CI, 1.14-1.25) and maximal expiratory pressure (4 trials; mean increase, 9 cm H 2 O; 95% CI, 5-14 cm H 2 O). IMT was associated with a shorter duration of ventilation (nine trials; mean difference, 4.1 d; 95% CI, 0.8-7.4 d) and a shorter duration of weaning (eight trials; mean difference, 2.3 d; 95% CI, 0.7-4.0 d), but confidence in these pooled estimates was low owing to methodological limitations, including substantial statistical and methodological heterogeneity. Conclusions: Most studies of IMT in critically ill patients have employed inspiratory threshold loading. IMT is feasible and well tolerated in critically ill patients and improves both inspiratory and expiratory muscle strength. The impact of IMT on clinical outcomes requires future confirmation.

AB - Rationale: Respiratory muscle weakness is common in critically ill patients; the role of targeted inspiratory muscle training (IMT) in intensive care unit rehabilitation strategies remains poorly defined. Objectives: The primary objective of the present study was to describe the range and tolerability of published methods for IMT. The secondary objectives were to determine whether IMT improves respiratory muscle strength and clinical outcomes in critically ill patients. Methods: We conducted a systematic review to identify randomized and nonrandomized studies of physical rehabilitation interventions intended to strengthen the respiratory muscles in critically ill adults. We searched the MEDLINE, Embase, HealthSTAR, CINAHL, and CENTRAL databases (inception to September Week 3, 2017) and conference proceedings (2012 to 2017). Data were independently extracted by two authors and collected on a standardized report form. Results: A total of 28 studies (N = 1,185 patients) were included. IMT was initiated during early mechanical ventilation (8 studies), after patients proved difficult to wean (14 studies), or after extubation (3 studies), and 3 other studies did not report exact timing. Threshold loading was the most common technique; 13 studies employed strength training regimens, 11 studies employed endurance training regimens, and 4 could not be classified. IMT was feasible, and there were few adverse events during IMT sessions (nine studies; median, 0%; interquartile range, 0-0%). In randomized trials (n = 20), IMT improved maximal inspiratory pressure compared with control (15 trials; mean increase, 6 cm H 2 O; 95% confidence interval [CI], 5-8 cm H 2 O; pooled relative ratio of means, 1.19; 95% CI, 1.14-1.25) and maximal expiratory pressure (4 trials; mean increase, 9 cm H 2 O; 95% CI, 5-14 cm H 2 O). IMT was associated with a shorter duration of ventilation (nine trials; mean difference, 4.1 d; 95% CI, 0.8-7.4 d) and a shorter duration of weaning (eight trials; mean difference, 2.3 d; 95% CI, 0.7-4.0 d), but confidence in these pooled estimates was low owing to methodological limitations, including substantial statistical and methodological heterogeneity. Conclusions: Most studies of IMT in critically ill patients have employed inspiratory threshold loading. IMT is feasible and well tolerated in critically ill patients and improves both inspiratory and expiratory muscle strength. The impact of IMT on clinical outcomes requires future confirmation.

KW - Artificial respiration

KW - Inspiratory muscle training

KW - Physical therapy

KW - Respiratory muscles

KW - Weaning

UR - http://www.scopus.com/inward/record.url?scp=85048107050&partnerID=8YFLogxK

UR - http://www.mendeley.com/research/inspiratory-muscle-rehabilitation-critically-ill-adults-systematic-review-metaanalysis

U2 - 10.1513/AnnalsATS.201712-961OC

DO - 10.1513/AnnalsATS.201712-961OC

M3 - Article

VL - 15

SP - 735

EP - 744

JO - Proceedings of the American Thoracic Society

JF - Proceedings of the American Thoracic Society

SN - 1546-3222

IS - 6

ER -