Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients
Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients
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DOI：
10.1590/s1807-59322005000600009
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发表时间：
2005-12-01
期刊：
影响因子：
2.7
通讯作者：
Deheinzelin, Daniel
中科院分区：
文献类型：
--
作者：
Caruso, Pedro;Denari, Silvia DC;Deheinzelin, Daniel
目的：有创机械通气与并发症相关，其缩写是可取的。工作量增加、吸气肌力量和耐力下降之间的不平衡是呼吸机依赖的重要决定因素。由于呼吸肌萎缩、危重疾病或类固醇的使用，可能会出现耐力低下的情况。特定的吸气肌训练可以增加或保持耐力。该研究的目的是检验以下假设：从机械通气开始进行吸气肌训练会缩短脱机持续时间并降低再插管率。作为次要目标，我们描述了有或没有吸气肌训练时吸气肌力量的演变。方法：在成人临床外科重症监护病房进行前瞻性随机临床试验。 12 名患者每天训练两次吸气肌，13 名患者没有训练（对照）。根据最大吸气压力调整呼吸机的灵敏度进行训练。患者每天接受最大吸气压监测。 结果：撤机持续时间（对照组 31 +/- 22 小时，训练组 23 +/- 11 小时；P = .24）和再插管率（对照组 5 次，训练组 3 次；P = .39）没有统计学差异。对照组的最大吸气压呈现适度增加的趋势。相比之下，训练组则出现小幅下降（P = .34）。结论：在急性危重症患者中，从机械通气开始进行吸气肌训练既不会缩短撤机时间，也不会降低再插管率。无论有或没有这种特定的吸气肌训练，吸气肌力量在机械通气过程中往往保持恒定。
PURPOSE: Invasive mechanical ventilation is associated with complications, and its abbreviation is desirable. The imbalance between increased workload, decreased inspiratory muscle strength and endurance is an important determinant of ventilator dependence. Low endurance may be present due to respiratory muscle atrophy, critical illness, or steroid use. Specific inspiratory muscle training may increase or preserve endurance. The objective of the study was to test the hypothesis that inspiratory muscle training from the beginning of mechanical ventilation would abbreviate the weaning duration and decrease reintubation rate. As a secondary objective, we described the evolution of inspiratory muscle strength with and without inspiratory muscle training.METHODS: Prospective, randomized clinical trial in an adult clinical-surgical intensive care unit. Twelve patients trained the inspiratory muscles twice a day, and 13 patients did not (control). Training was performed adjusting the sensitivity of the ventilator based on the maximal inspiratory pressure. Patients underwent daily surveillance of the maximal inspiratory pressure.RESULTS: The weaning duration (31 +/- 22 hr, control and 23 +/- 11 hr, training group; P = .24) and reintubation rate (5 control and 3 training group; P = .39) were not statistically different. The maximal inspiratory pressure of the control group showed a trend toward a modest increase. In contrast, the training group showed a small decrease (P = .34).CONCLUSIONS: In acute critically ill patients, inspiratory muscle training from the beginning of mechanical ventilation neither abbreviated the weaning duration, nor decreased the reintubation rate. Inspiratory muscle strength tended to stay constant, along the mechanical ventilation, with or without this specific inspiratory muscle training.