Respiratory Muscle Training in Ventilator Dependent Pts.

描述(申请人提供)：未能使患者脱离机械通气(MV)是一个医疗、经济和社会问题。患者在ICU接受机械通气治疗的时间中，约有40%用于脱机。已经发表了许多预测脱机结果的算法，但很少有研究检验脱机失败的具体治疗方法。传统的机械通气撤机方法侧重于优化医疗护理和患者-呼吸机接口，但越来越多的证据表明，机械通气使用会导致吸气肌无力，而这种无力是机械通气依赖的主要原因。我们开发了一种实用的康复方法来改善MV依赖患者的吸气肌力，以促进脱机。我们组建了一支由医生、康复专家、呼吸生理学家、沟通专家组成的团队，并开发了一套系统的康复方法来治疗由于吸气肌无力而导致的MV依赖。我们建议研究阈值吸气肌力训练(IMST)改善MV依赖患者脱机结局的有效性。我们将检验阈值IMST将增加MV依赖患者的吸气压力产生能力的假设，减少这些患者脱离MV所需的时间，并增加患者的撤机比例。将入住ICU的MV依赖患者分为2组：假手术组和IMST组。两组都将接受相同的MV管理策略，并在允许的情况下逐步延长自主呼吸试验。IMST组将接受长达6周的高强度、低重复训练，使用门槛吸气肌肉训练器。假人组将接受同等时间的培训计划。提供假冒和假冒治疗的人员和受试者将对治疗视而不见。两组将在断奶的受试者数量、方案完成后断奶所需的时间以及呼吸模式的变化方面进行比较。这项工作的结果将为MV依赖患者的吸气肌强化康复方法提供新的信息。这项研究将阐明这些患者对MV依赖的机制，并为因呼吸肌无力而依赖MV的患者提供有效的治疗策略。

DESCRIPTION (provided by applicant): Failure to wean patients from mechanical ventilation (MV) is a medical, economic and social problem. Approximately 40% of the time patients spend in ICU on MV is devoted to weaning. Numerous algorithms to predict weaning outcome have been published, but few studies have examined the specific treatment of weaning failure. The traditional approach to MV weaning has focused on optimizing medical care and the patient-ventilator interface, but there is growing evidence that MV use leads to inspiratory muscle weakness and this weakness is a major contributor to MV dependence. We have developed a practical rehabilitation approach to improving inspiratory muscle strength in MV dependent patients to facilitate weaning. We have assembled a team of physicians, a rehabilitation specialist, a respiratory physiologist, a communication specialist and developed a systematic rehabilitation approach to treating MV dependence due to inspiratory muscle weakness. We propose to study the effectiveness of threshold inspiratory muscle strength training (IMST) to improve weaning outcome in MV dependent patients. We will test the hypothesis that threshold IMST will increase the inspiratory pressure generating capacity of MV dependent patients, decrease the time required to wean these patients from MV and increase the proportion of patients weaned. MV dependent patients in ICUs will be divided into 2 groups: a SHAM group and an IMST group. Both groups will receive an identical MV management strategy with progressively lengthening spontaneous breathing trials as tolerated. The IMST group will receive up to 6 weeks of high intensity, low repetition training using a threshold inspiratory muscle trainer. The SHAM group will receive a training program for an equal period of time. The personnel providing the IMST and SHAM treatments and the subjects will be blinded to the treatments. Groups will be compared on the number of subjects weaned, the duration of time needed to wean following protocol completion and changes in breathing pattern. The results of this work will provide new information on an inspiratory muscle strengthening rehabilitation approach to weaning for MV dependent patients. This study will illuminate the mechanisms mediating MV dependence in these patients and lead to effective treatment strategies for patients dependent upon MV due to respiratory muscle weakness.