Respiratory dysfunction in ventilated patients: Can inspiratory muscle training help

Bernie BISSETT, Isabel Leditschke, Jennifer Paratz, Robert Boots

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Respiratory muscle dysfunction is associated with prolonged and difficult weaning from mechanical ventilation. This dysfunction in ventilator-dependent patients is multifactorial: there is evidence that inspiratory muscle weakness is partially explained by disuse atrophy secondary to ventilation, and positive end-expiratory pressure can further reduce muscle strength by negatively shifting the length-tension curve of the diaphragm. Polyneuropathy is also likely to contribute to apparent muscle weakness in critically ill patients, and nutritional and pharmaceutical effects may further compound muscle weakness. Moreover, psychological influences, including anxiety, may contribute to difficulty in weaning. There is recent evidence that inspiratory muscle training is safe and feasible in selected ventilator-dependent patients, and that this training can reduce the weaning period and improve overall weaning success rates. Extrapolating from evidence in sports medicine, as well as the known effects of inspiratory muscle training in chronic lung disease, a theoretical model is proposed to describe how inspiratory muscle training enhances weaning and recovery from mechanical ventilation. Possible mechanisms include increased protein synthesis (both Type 1 and Type 2 muscle fibres), enhanced limb perfusion via dampening of a sympathetically-mediated metaboreflex, reduced lactate levels and modulation of the perception of exertion, resulting in less dyspnoea and enhanced exercise capacity
Original languageEnglish
Pages (from-to)236-246
Number of pages11
JournalAnaesthesia and Intensive Care
Volume40
Publication statusPublished - 2012

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Weaning
Muscle Weakness
Muscles
Mechanical Ventilators
Artificial Respiration
Atrophic Muscular Disorders
Fast-Twitch Muscle Fibers
Sports Medicine
Respiratory Muscles
Positive-Pressure Respiration
Polyneuropathies
Muscle Strength
Diaphragm
Critical Illness
Dyspnea
Lung Diseases
Ventilation
Lactic Acid
Chronic Disease
Theoretical Models

Cite this

BISSETT, Bernie ; Leditschke, Isabel ; Paratz, Jennifer ; Boots, Robert. / Respiratory dysfunction in ventilated patients: Can inspiratory muscle training help. In: Anaesthesia and Intensive Care. 2012 ; Vol. 40. pp. 236-246.
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Respiratory dysfunction in ventilated patients: Can inspiratory muscle training help. / BISSETT, Bernie; Leditschke, Isabel; Paratz, Jennifer; Boots, Robert.

In: Anaesthesia and Intensive Care, Vol. 40, 2012, p. 236-246.

Research output: Contribution to journalArticle

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AB - Respiratory muscle dysfunction is associated with prolonged and difficult weaning from mechanical ventilation. This dysfunction in ventilator-dependent patients is multifactorial: there is evidence that inspiratory muscle weakness is partially explained by disuse atrophy secondary to ventilation, and positive end-expiratory pressure can further reduce muscle strength by negatively shifting the length-tension curve of the diaphragm. Polyneuropathy is also likely to contribute to apparent muscle weakness in critically ill patients, and nutritional and pharmaceutical effects may further compound muscle weakness. Moreover, psychological influences, including anxiety, may contribute to difficulty in weaning. There is recent evidence that inspiratory muscle training is safe and feasible in selected ventilator-dependent patients, and that this training can reduce the weaning period and improve overall weaning success rates. Extrapolating from evidence in sports medicine, as well as the known effects of inspiratory muscle training in chronic lung disease, a theoretical model is proposed to describe how inspiratory muscle training enhances weaning and recovery from mechanical ventilation. Possible mechanisms include increased protein synthesis (both Type 1 and Type 2 muscle fibres), enhanced limb perfusion via dampening of a sympathetically-mediated metaboreflex, reduced lactate levels and modulation of the perception of exertion, resulting in less dyspnoea and enhanced exercise capacity

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