Respiratory Muscle Training in Ventilator Dependent Pts.

依赖呼吸机的患者的呼吸肌训练。

• 批准号: 7152934
• 负责人: ANATOLE Daniel MARTIN
• 金额: $ 30.07万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-12-15 至 2008-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7152934
• 关键词: Algorithms; Blinded; Breathing; Breathing Exercises; Caring; Classification; Communication; Dependence; Double-Blind Method; Effectiveness; Environmental air flow; Failure; Future; Goals; Human Resources; Individual; Institution; Investigation; Lead; Lung diseases; Malnutrition; Mechanical ventilation; Mediating; Medical; Medical Economics; Methods; Muscle; Muscle Fatigue; Muscle Weakness; Numbers; Operative Surgical Procedures; Outcome; Patient Care; Patients; Pattern; Physicians; Placebos; Probability; Protocols documentation; Publishing; Purpose; Rate; Rehabilitation therapy; Research; Resolution; Respiratory Failure; Respiratory Muscles; Social Problems; Specialist; Spinal cord injury; Techniques; Testing; Time; Training; Training Programs; Ventilator; Ventilator Weaning; Weaning; Week; Work; Work of Breathing; experience; improved; muscle strength; novel; pressure; programs; relating to nervous system; respiratory; salicylhydroxamic acid; strength training

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.

描述（由申请人提供）：无法使患者脱离机械通气（MV）是一个医学、经济和社会问题。患者在ICU接受MV的时间中约有40%用于脱机。已经发表了许多预测断奶结果的算法，但很少有研究探讨断奶失败的具体治疗方法。MV脱机的传统方法侧重于优化医疗护理和患者-呼吸机界面，但越来越多的证据表明，MV使用导致吸气肌无力，这种无力是MV依赖的主要原因。我们已经开发了一种实用的康复方法，以改善MV依赖患者的吸气肌力量，以促进脱机。我们已经组建了一个由医生、康复专家、呼吸生理学家和沟通专家组成的团队，并开发了一种系统的康复方法来治疗由于吸气肌无力引起的MV依赖。我们建议研究阈值吸气肌肉力量训练（IMST），以改善MV依赖患者的脱机结果的有效性。我们将检验以下假设：阈值IMST将增加MV依赖患者的吸气压力生成能力，减少这些患者脱离MV所需的时间，并增加脱离MV的患者比例。ICU中的MV依赖患者将分为2组：SHAM组和IMST组。两组将接受相同的MV管理策略，并在耐受范围内逐渐延长自主呼吸试验。IMST组将接受长达6周的高强度，低重复训练，使用阈值吸气肌肉训练器。SHAM组将接受相同时间的培训计划。提供IMST和SHAM治疗的人员和受试者将对治疗设盲。将比较各组中断奶的受试者数量、方案完成后断奶所需的持续时间和呼吸模式的变化。这项工作的结果将提供新的信息，吸气肌加强康复方法，以脱机的MV依赖患者。本研究将阐明介导这些患者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。