Influence of inspiratory muscle training on weaning patients from mechanical ventilation: a systematic review

摘要

Introduction: The inability of respiratory muscles to generate force and endurance is recognized as an important cause of failure in weaning patients from invasive mechanical ventilation (IMV). Thus, inspiratory muscle training (IMT) might be an interesting treatment option for patients with prolonged IMV weaning. Objective: The aim of this systematic literature review was to evaluate the effectiveness of inspiratory muscle training in weaning patients from mechanical ventilation and to identify the most effective type of training for this particular purpose. Methods: We searched PubMed, LILACS, PEDro and Web of Science for randomized clinical trials published in English or Portuguese from January 1990 until March 2015. Results: Eighty-nine studies were identified of which five were selected. A total of 267 patients participated in the five randomized clinical trials analyzed here. IMV duration before onset of training varied greatly among subjects. Three studies performed IMT using a threshold device and two studies used adjustments of ventilator pressure sensitivity. Four studies have shown that IMT resulted in a significant increase in inspiratory maximal pressure. Only two studies, however, have reported that IMT resulted in higher success rates in weaning patients from IMV. One study has found that patients showed a shorter ventilator weaning duration after IMT. Conclusion: IMT using pressure threshold devices results in increased inspiratory muscle strength and can therefore be considered a more effective treatment option and with the potential to optimize ventilator weaning success in patients at risk of prolonged IMV.