Inspiratory muscle training in difficult to wean patients

Inspiratory Muscle training in difficult to wean patients

Maher AlQuaimi, MsRC,AEA,RRT-NPS

Faculty member at Imam bin Abdulrahman University

Rresearch assistant Newcastle University

• Abo Hammad is a 70 years old patient with COPD. S/P CABAG X 2. admitted to ICU on MV for the last 10 days. Patient is conscious.

• On day 20, tracheostomy was performed and he was transferred to Long term unit.

• On day 50, patient developed multi drug resistance pneumonia.

• On day 60, patients passed away !

Survival vs. days on vent

Esteban et al JAMA(2002)

Outlines

• Overview physiology of diaphragm

• How diaphragm weakness happens

• Inspiratory muscle training in difficult to wean patients

Schellekens, et al ( 2016) critical care

American Journal of Respiratory and Critical Care Medicine Volume 192 Number 9 | November 1 2015

Is it only diaphragm ?

Nakanishi, et al, 2017 , Intensive care med

Schellekens, et al ( 2016) critical care

Inspiratory muscle training to enhance recovery from mechanical ventilation: a randomised trial

• RCT for patients on MV for > 7 days

• N = 28 ( IMT) , N = 30 control

• IMT of 50% MIP

• Improvement in :• MIP and quality of life in IMT group.

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Bissett BM, et al. Thorax 2016;

Elkings, Dentice. Journal of Physiotherapy (2015) 125–134

Training technique sensitivity change or thershould device

Levels 20% to 50% of MIP then increase by 10%

Frequency 2 To 6 sits

Daily training Twice

Airway type ETT or TT

Compliance More 84%

Adverse events

Termination criteria Paradoxical Breathing, SVT, tachypnoea, desaturation, hemodynamic instability

Figure 2

Journal of Physiotherapy 2015 61, 125-134DOI: (10.1016/j.jphys.2015.05.016)

Maximum Inspiratory pressure


Weaning success


Rapid Shallow breathing index


Weaning duration days


Survival: not significant

Inspiratory Muscle Training in the Intensive Care Unit: A New Perspective ( Oct, 2017)

• Tracheostomized patients, on MV for more than 21 + - 9.8 days

• Used electronic IMT device ( Power Breathe)

• No significant difference in RSBI, however, it was it severely decreased to start with.

• Significantly shorter weaning time

Tonella et al,(2017) Journal of clinical medicine research

Move it or lose it

In summary:

• IMT is safe intervention and feasible in critical care patients.

• It can be used on intubated or non intubated.

• There is no published study that compared the performance of different devices.

• IMT of 30% MIP seems a good starting point.

• Reported complications were very minimal and easily controlled.

• More research is needed !

• Abo Hammad is a 70 years old patient with COPD. S/P CABAG X 2. admitted to ICU on MV for the last 10 days. Patient is conscious. IMT at 30% was started twice a day.

• On day 20, tracheostomy was performed and he was transferred to Long term unit. IMT is now at 50% tolerated very well.

• On day 50, patient developed multi drug resistance pneumonia.

• On day 50, patient was off ventilator and maintaining ATM

• On day 60, patient was transferred to the wards alive

Thank you…

Inspiratory muscle training in difficult to wean patients

Health & Medicine

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