Inspiratory muscle training for intensive care patients: a multidisciplinary practical guide for clinicians.

Bernie BISSETT, Anne I. Leditschke, Vince Marzano, Margot GREEN, Sarajane Collins, Frank Van Haren

Research output: Contribution to journalArticle

3 Citations (Scopus)
37 Downloads (Pure)

Abstract

Objectives: To describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU). Background: Inspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients. Methods: Patients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set. Results: Using this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days’ duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT. Conclusions: This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.

Original languageEnglish
JournalAustralian Critical Care
Early online date19 Jul 2018
DOIs
Publication statusPublished - 2018

Fingerprint

Critical Care
Muscles
Artificial Respiration
Mechanical Ventilators
Intensive Care Units
Quality of Life
Tracheostomy
Physical Therapists
Muscle Weakness
Muscle Strength
Nurses
Guidelines
Pressure
Equipment and Supplies

Cite this

BISSETT, Bernie ; Leditschke, Anne I. ; Marzano, Vince ; GREEN, Margot ; Collins, Sarajane ; Van Haren, Frank . / Inspiratory muscle training for intensive care patients: a multidisciplinary practical guide for clinicians. In: Australian Critical Care. 2018.
@article{6b9af7cd222d41b3a73a138f6cb35e8c,
title = "Inspiratory muscle training for intensive care patients: a multidisciplinary practical guide for clinicians.",
abstract = "Objectives: To describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU). Background: Inspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients. Methods: Patients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50{\%} of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set. Results: Using this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days’ duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT. Conclusions: This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.",
keywords = "Physiotherapy, Physiotherapy (techniques), Respiratory Muscles, Intensive Care, critical care, Exercise Therapy, Intensive care, Critical care, Breathing exercises",
author = "Bernie BISSETT and Leditschke, {Anne I.} and Vince Marzano and Margot GREEN and Sarajane Collins and {Van Haren}, Frank",
year = "2018",
doi = "10.1016/j.aucc.2018.06.001",
language = "English",
journal = "Australian Critical Care",
issn = "1036-7314",
publisher = "Elsevier Ireland Ltd",

}

Inspiratory muscle training for intensive care patients: a multidisciplinary practical guide for clinicians. / BISSETT, Bernie; Leditschke, Anne I.; Marzano, Vince; GREEN, Margot; Collins, Sarajane; Van Haren, Frank .

In: Australian Critical Care, 2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Inspiratory muscle training for intensive care patients: a multidisciplinary practical guide for clinicians.

AU - BISSETT, Bernie

AU - Leditschke, Anne I.

AU - Marzano, Vince

AU - GREEN, Margot

AU - Collins, Sarajane

AU - Van Haren, Frank

PY - 2018

Y1 - 2018

N2 - Objectives: To describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU). Background: Inspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients. Methods: Patients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set. Results: Using this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days’ duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT. Conclusions: This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.

AB - Objectives: To describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU). Background: Inspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients. Methods: Patients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set. Results: Using this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days’ duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT. Conclusions: This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.

KW - Physiotherapy

KW - Physiotherapy (techniques)

KW - Respiratory Muscles

KW - Intensive Care

KW - critical care

KW - Exercise Therapy

KW - Intensive care

KW - Critical care

KW - Breathing exercises

UR - http://www.scopus.com/inward/record.url?scp=85049617343&partnerID=8YFLogxK

UR - https://doi.org/10.1016/j.aucc.2018.06.001

UR - http://www.mendeley.com/research/inspiratory-muscle-training-intensive-care-patients-multidisciplinary-practical-guide-cliniciansncnd

U2 - 10.1016/j.aucc.2018.06.001

DO - 10.1016/j.aucc.2018.06.001

M3 - Article

JO - Australian Critical Care

JF - Australian Critical Care

SN - 1036-7314

ER -