Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial
Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial
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DOI：
10.1186/cc10081
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发表时间：
2011-01-01
期刊：
影响因子：
15.1
通讯作者：
Gabrielli, Andrea
中科院分区：
文献类型：
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作者：
Martin, A. Daniel;Smith, Barbara K.;Gabrielli, Andrea
大多数患者很容易从机械通气（MV）支持中解脱出来，然而，10% - 15%的患者经历了断奶失败（FTW）。FTW患者约占所有MV天数的40%，临床结果明显较差。MV诱发的吸气肌无力被认为是FTW的一个因素，最近的研究证实了MV患者的吸气肌无力。方法：我们进行了一项单中心、单盲、随机对照试验，以检验吸气肌力量训练（IMST）是否能改善FTW患者的脱机结局。在评估参与的129名患者中，69名患者入组并进行了研究。35名受试者被随机分配到IMST组，34名受试者被分配到SHAM组。IMST使用阈值吸气装置进行，设置在可耐受的最高压力并每日进展。SHAM训练提供恒定的低吸气压力负荷。受试者完成4组6-10次训练呼吸，每周五天。受试者还按照每个方案每天进行逐步延长呼吸时间的试验。脱机标准为连续72小时无MV支持。受试者盲法分组，治疗至断奶或28天。结果：各组在基线时的人口学和临床变量具有可比性。IMST组和SHAM组在干预开始前分别获得41.9 +/- 25.5天和47.3 +/- 33.0天的MV支持，P = 0.36。IMST组和SHAM组分别参加9.7 +/- 4.0次和11.0 +/- 4.8次训练，P = 0.09。SHAM组训练前后最大吸气压力（MIP）变化不显著（-43.5 +/- 17.8 vs -45.1 +/- 19.5 cm H2O, P = 0.39），而IMST组的MIP增加（-44.4 +/- 18.4 vs -54.1 +/- 17.8 cm H2O, P < 0.0001）。在IMST或SHAM治疗期间未观察到不良事件。35名IMST受试者中有25人断奶（71%，95%可信区间(CI) = 55%至84%），而34名SHAM受试者中有16人断奶（47%,95% CI = 31%至63%），P = 0.039。需要治疗的患者数量为4 （95% CI = 2 ~ 80）。结论：与SHAM治疗相比，IMST方案可导致FTW患者的MIP增加并改善脱机结果。
Introduction: Most patients are readily liberated from mechanical ventilation (MV) support, however, 10% - 15% of patients experience failure to wean (FTW). FTW patients account for approximately 40% of all MV days and have significantly worse clinical outcomes. MV induced inspiratory muscle weakness has been implicated as a contributor to FTW and recent work has documented inspiratory muscle weakness in humans supported with MV.Methods: We conducted a single center, single-blind, randomized controlled trial to test whether inspiratory muscle strength training (IMST) would improve weaning outcome in FTW patients. Of 129 patients evaluated for participation, 69 were enrolled and studied. 35 subjects were randomly assigned to the IMST condition and 34 to the SHAM treatment. IMST was performed with a threshold inspiratory device, set at the highest pressure tolerated and progressed daily. SHAM training provided a constant, low inspiratory pressure load. Subjects completed 4 sets of 6-10 training breaths, 5 days per week. Subjects also performed progressively longer breathing trials daily per protocol. The weaning criterion was 72 consecutive hours without MV support. Subjects were blinded to group assignment, and were treated until weaned or 28 days.Results: Groups were comparable on demographic and clinical variables at baseline. The IMST and SHAM groups respectively received 41.9 +/- 25.5 vs. 47.3 +/- 33.0 days of MV support prior to starting intervention, P = 0.36. The IMST and SHAM groups participated in 9.7 +/- 4.0 and 11.0 +/- 4.8 training sessions, respectively, P = 0.09. The SHAM group's pre to post-training maximal inspiratory pressure (MIP) change was not significant (-43.5 +/- 17.8 vs. -45.1 +/- 19.5 cm H2O, P = 0.39), while the IMST group's MIP increased (-44.4 +/- 18.4 vs. -54.1 +/- 17.8 cm H2O, P < 0.0001). There were no adverse events observed during IMST or SHAM treatments. Twenty-five of 35 IMST subjects weaned (71%, 95% confidence interval (CI) = 55% to 84%), while 16 of 34 (47%, 95% CI = 31% to 63%) SHAM subjects weaned, P = .039. The number of patients needed to be treated for effect was 4 (95% CI = 2 to 80).Conclusions: An IMST program can lead to increased MIP and improved weaning outcome in FTW patients compared to SHAM treatment.