Respiratory Muscle Training in Ventilator Dependent Pts.

描述（由申请人提供）：患者不能脱离机械通气（MV）是一个医学、经济和社会问题。患者在ICU接受MV治疗的时间中约有40%用于脱机。许多预测断奶结果的算法已经发表，但很少有研究检查断奶失败的具体治疗。传统的中压脱机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，中压的使用会导致吸气肌无力，而这种无力是中压依赖的主要原因。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量，以促进脱机。我们组建了一个由内科医生、康复专家、呼吸生理学家、通讯专家组成的团队，并开发了一种系统的康复方法来治疗因吸气肌无力引起的MV依赖。我们建议研究阈值吸气肌力量训练（IMST）对改善MV依赖患者脱机结果的有效性。我们将验证阈值IMST会增加MV依赖患者的吸气压力产生能力，减少这些患者从MV中断奶所需的时间，并增加断奶患者的比例。icu中MV依赖患者将分为2组：SHAM组和IMST组。两组均接受相同的MV管理策略，在可容忍的情况下逐步延长自主呼吸试验。IMST组将使用阈值吸气肌训练器进行长达6周的高强度、低重复训练。SHAM组将接受同等时间的培训计划。提供IMST和SHAM治疗的人员和受试者将对治疗不知情。各组将比较断奶受试者的数量、方案完成后断奶所需的时间以及呼吸模式的变化。这项工作的结果将为吸气肌增强康复方法提供新的信息，以帮助MV依赖患者脱机。本研究将阐明这些患者中压依赖的机制，并为呼吸肌无力的中压依赖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.