Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial
Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial
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DOI：
10.1016/s1836-9553(10)70022-9
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发表时间：
2010-01-01
影响因子：
12.1
通讯作者：
Martin Dantas, Estelio Henrique
中科院分区：
文献类型：
--
作者：
Cader, Samaria Ali;de Souza Vale, Rodrigo Gomes;Martin Dantas, Estelio Henrique
问题：吸气肌训练是否可以改善插管老年人的最大吸气压？它是否可以改善呼吸模式并缩短机械通气脱机时间？设计：采用隐藏分配和意向治疗分析的随机试验。参与者：41 名插管的老年人，他们在重症监护病房接受了至少 48 小时的机械通气。干预：实验组接受常规护理加上使用阈值装置的吸气肌训练，初始负荷为最大吸气压力的30%，每天增加10%（绝对）。从断奶开始到拔管，训练每周 7 天，每天两次，每次 5 分钟。对照组仅接受常规护理。结果测量：主要结果是断奶期间最大吸气压的变化。次要结果是脱机时间（即从压力支持通气开始到成功拔管）和托宾指数（即 1 分钟自主呼吸试验期间的呼吸频率除以潮气量）。结果：实验组的最大吸气压力比对照组显着增加（MD 7.6 cmH(2)O，95% CI 5.8至9.4）。实验组的托宾指数比对照组显着下降（MD 8.3 br/min/L，95% CI 2.9至13.7）。在那些没有死亡或接受气管切开术的患者中，实验组的断奶时间明显短于对照组（MD 1.7 天，95% CI 0.4 至 3.0）。结论：对于插管的老年人，吸气肌训练可以改善最大吸气压和托宾指数，并缩短一些患者的脱机时间。试用注册：NCT00922493。 [Cader SA、Vale RGS、Castro JC、Bacelar SC、Biehl C、Gomes MCV、Cabrera WE、Dantas EHM (2010) 吸气肌训练可改善最大吸气压，并可能有助于老年插管患者脱机：一项随机试验。物理治疗杂志 56：171-177]
Questions: Does inspiratory muscle training improve maximal inspiratory pressure in intubated older people? Does it improve breathing pattern and time to wean from mechanical ventilation? Design: Randomised trial with concealed allocation and intention-to-treat analysis. Participants: 41 elderly, intubated adults who had been mechanically ventilated for at least 48 hr in an intensive care unit. Intervention: The experimental group received usual care plus inspiratory muscle training using a threshold device, with an initial load of 30% of their maximal inspiratory pressure, increased by 10% (absolute) daily. Training was administered for 5 min, twice a day, 7 days a week from the commencement of weaning until extubation. The control group received usual care only. Outcome measures: The primary outcome was the change in maximal inspiratory pressure during the weaning period. Secondary outcomes were the weaning time (ie, from commencement of pressure support ventilation to successful extubation), and the index of Tobin (ie, respiratory rate divided by tidal volume during a 1-min spontaneous breathing trial). Results: Maximal inspiratory pressure increased significantly more in the experimental group than in the control group (MD 7.6 cmH(2)O, 95% CI 5.8 to 9.4). The index of Tobin decreased significantly more in the experimental group than in the control group (MD 8.3 br/min/L, 95% CI 2.9 to 13.7). In those who did not die or receive a tracheostomy, time to weaning was significantly shorter in the experimental group than in the control group (MD 1.7 days, 95% CI 0.4 to 3.0). Conclusions: In intubated older people, inspiratory muscle training improves maximal inspiratory pressure and the index of Tobin, with a reduced weaning time in some patients. Trial registration: NCT00922493. [Cader SA, Vale RGS, Castro JC, Bacelar SC, Biehl C, Gomes MCV, Cabrera WE, Dantas EHM (2010) Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial. Journal of Physiotherapy 56: 171-177]