Respiratory Muscle Training in Ventilator Dependent Pts.

依赖呼吸机的患者的呼吸肌训练。

• 批准号: 6999336
• 负责人: ANATOLE Daniel MARTIN
• 金额: $ 33.03万
• 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/6999336
• 关键词: clinical research; disease /therapy duration; exercise; human subject; intensive care; medical rehabilitation related tag; method development; muscle strength; patient oriented research; pulmonary respiration; rehabilitation; respirators; respiratory airway pressure; respiratory muscles

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）：未能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 进行 MV 治疗时，大约 40% 的时间用于撤机。已经发表了许多预测脱机结果的算法，但很少有研究探讨脱机失败的具体治疗方法。 MV 撤机的传统方法侧重于优化医疗护理和患者与呼吸机接口，但越来越多的证据表明 MV 的使用会导致吸气肌无力，而这种无力是导致 MV 依赖的主要原因。我们开发了一种实用的康复方法来提高 MV 依赖患者的吸气肌力量，以促进脱机。我们组建了一个由医生、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因吸气肌无力而导致的 MV 依赖性。我们建议研究阈值吸气肌力量训练 (IMST) 的有效性，以改善 MV 依赖患者的脱机结果。我们将检验这样的假设：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 依赖患者将被分为 2 组：SHAM 组和 IMST 组。两组将接受相同的 MV 管理策略，并在耐受范围内逐步延长自主呼吸试验。 IMST 组将使用阈值吸气肌训练器接受长达 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。各组将比较脱机的受试者数量、方案完成后脱机所需的持续时间以及呼吸模式的变化。这项工作的结果将为 MV 依赖患者的脱机吸气肌强化康复方法提供新信息。这项研究将阐明这些患者中介导 MV 依赖性的机制，并为因呼吸肌无力而依赖 MV 的患者提供有效的治疗策略。