Suárez Suárez LF1, Saavedra Torres NE1, Hernández-Álvarez ED1, León Cárdenas EG1
1Universidad Nacional de Colombia, Department of Human Body Movement, Bogota, Colombia
Background: Nearly 25% of the population that is in the intensive care unit (ICU) and receives management with invasive mechanical ventilation (IMV), has difficulty disconnection and failure in extubation due to diaphragmatic dysfunction induced by the ventilator (DDIV). This weakness is associated with adverse clinical outcomes that consume a significant proportion of health resources with increased mortality, morbidity, and decreased quality of life. The work that is done on the respiratory musculature will allow the patient to have spontaneous breaths, with a view to an early disconnection of the ventilator and the discharge from the ICU.
Purpose: Determine the effect of Respiratory Muscle Training (RMT) by Threshold IMT on the inspiratory force and success of extubation in patients under VM pilot study.
Methods: Quasi-experimental study on pilot phase of pre and post intervention comparison. Participants included in the study were 10 patients (6 women, 4 men) who received IMV. They were followed up to 48 hours after extubation, the intervention was RMT which was applied to participants using a Threshold IMT Phillips® with an initial load of 30% of their maximum inspiratory pressure (MIP), with a regimen of 5 sets of 6 breaths, twice a day until extubation. After extubation, follow-up was performed at 6, 12, 24, and 48 hours, measuring maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP) as the primary outcome. Secondary outcomes were success in extubation and length of weaning period. Measurements were analyzed using IBM SPSS Statistics 24, an ANOVA analysis with an IC: 95% was used.
Results: RMT significantly increases the MIP and SNIP values indistinctly of the gender. There were a significant difference between the pre- and post-intervention SNIP values with an average increase of 18.9 cmH2O at 48 hours post extubation respect to the baseline (p = 0.001). For the PIM variable, significant differences were observed after training, showing a progressive increase of up to 13.41 cmH2O at 48 hours post extubation (p = 0.001). All extubations were successful. The length in the ICU for the study population was 6.8 (4.8) days with an average duration of days in IMV of 3.7 (4.2) days and the duration of weaning was 2.9 (2.3) days.
Conclusion(s): This pilot study shows that RMT with Threshold IMT device turns out to be a form of intervention that contributes positively to the early and successful release of IMV, providing a progressive increase until 48 hours after extubation of the values of MIP and SNIP.
Implications: The RMT is a positive determinant to shorten the lengths of hospital stay in ICU, therefore it becomes an essential approach in which to make the physiotherapist in the critical care.
Keywords: Respiratory Muscle training, Diaphragmatic dysfunction induced by the ventilato, Ventilation Weaning
Funding acknowledgements: To Medicine Faculty of Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, and people who participate in the investigation.
Purpose: Determine the effect of Respiratory Muscle Training (RMT) by Threshold IMT on the inspiratory force and success of extubation in patients under VM pilot study.
Methods: Quasi-experimental study on pilot phase of pre and post intervention comparison. Participants included in the study were 10 patients (6 women, 4 men) who received IMV. They were followed up to 48 hours after extubation, the intervention was RMT which was applied to participants using a Threshold IMT Phillips® with an initial load of 30% of their maximum inspiratory pressure (MIP), with a regimen of 5 sets of 6 breaths, twice a day until extubation. After extubation, follow-up was performed at 6, 12, 24, and 48 hours, measuring maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP) as the primary outcome. Secondary outcomes were success in extubation and length of weaning period. Measurements were analyzed using IBM SPSS Statistics 24, an ANOVA analysis with an IC: 95% was used.
Results: RMT significantly increases the MIP and SNIP values indistinctly of the gender. There were a significant difference between the pre- and post-intervention SNIP values with an average increase of 18.9 cmH2O at 48 hours post extubation respect to the baseline (p = 0.001). For the PIM variable, significant differences were observed after training, showing a progressive increase of up to 13.41 cmH2O at 48 hours post extubation (p = 0.001). All extubations were successful. The length in the ICU for the study population was 6.8 (4.8) days with an average duration of days in IMV of 3.7 (4.2) days and the duration of weaning was 2.9 (2.3) days.
Conclusion(s): This pilot study shows that RMT with Threshold IMT device turns out to be a form of intervention that contributes positively to the early and successful release of IMV, providing a progressive increase until 48 hours after extubation of the values of MIP and SNIP.
Implications: The RMT is a positive determinant to shorten the lengths of hospital stay in ICU, therefore it becomes an essential approach in which to make the physiotherapist in the critical care.
Keywords: Respiratory Muscle training, Diaphragmatic dysfunction induced by the ventilato, Ventilation Weaning
Funding acknowledgements: To Medicine Faculty of Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, and people who participate in the investigation.
Topic: Critical care; Cardiorespiratory; Professional practice: other
Ethics approval required: Yes
Institution: Medicine Faculty of the Universidad Nacional de Colombia.
Ethics committee: Ethics Committee of Investigation
Ethics number: 001-015-18
All authors, affiliations and abstracts have been published as submitted.
