Similar Weaning Success Rate with High-Intensity and Sham Inspiratory Muscle Training: A Randomized Controlled Trial (IMweanT).

IF 19.3 1区医学 Q1 CRITICAL CARE MEDICINE American journal of respiratory and critical care medicine Pub Date : 2024-11-20 DOI:10.1164/rccm.202405-1042OC

Marine Van Hollebeke, Diego Poddighe, Mariana Hoffman, Beatrix Clerckx, Jan Muller, Zafeiris Louvaris, Greet Hermans, Rik Gosselink, Daniel Langer

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Abstract

Rationale: Inspiratory muscle training (IMT) improves respiratory muscle function in patients with weaning difficulties. IMT protocols involve performing daily sets of breaths against external loads. However, the impact of IMT on weaning outcomes while incorporating sham control interventions remains unclear.

Objectives: To compare the effects of a high-intensity IMT (Hi-IMT) intervention with a sham low-intensity (Lo-IMT) control group on weaning outcomes, respiratory muscle and pulmonary function 28 days after inclusion, in patients with weaning difficulties.

Methods: Both groups underwent daily IMT sessions until successful weaning or a maximum of 28 days. The Hi-IMT group (n=44, 61% male, 57±15 years) performed maximal inspirations initiated from residual volume against an external load representing 30-50% of maximal inspiratory pressure (PImax), while the control group (n=46, 52% male, 60±12 years) performed maximal inspirations against a load ≤10% PImax.

Measurements and main results: Training adherence (completed/planned sessions) was comparable between the groups (Hi-IMT: 77±20%, Lo-IMT: 72±17%, p=0.25). Weaning success (64% Hi-IMT and 76% Lo-IMT; p=0.43) and weaning duration (Hi-IMT: 45±48 days, Lo-IMT: 37±26 days, p=0.33) were similar between groups. Both groups similarly improved PImax (Hi-IMT: +15cmH2O [95%CI: 9 ; 20], Lo-IMT: +14cmH2O [95%CI: 9 ; 19], p=0.72). Forced vital capacity improved more in the Hi-IMT than Lo-IMT group (Hi-IMT: +0.33L [95%CI: 0.22 ; 0.43], Lo-IMT: +0.16L [95%CI: 0.07 ; 0.25], p=0.04).

Conclusions: Both high-intensity IMT and sham low-intensity IMT, with high adherence to the protocol, resulted in similar weaning success rates and pronounced improvements in maximal inspiratory muscle strength. Clinical trial registration available at www.

Clinicaltrials: gov, ID: NCT03240263.

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高强度吸气肌训练和假吸气肌训练的断奶成功率相似：随机对照试验（IMweanT）。

理由：吸气肌训练（IMT）可改善断奶困难患者的呼吸肌功能。吸气肌训练方案包括在外部负荷的作用下每天进行一组呼吸。然而，在进行假对照干预的同时，吸气肌训练对断奶结果的影响仍不清楚：比较高强度 IMT（Hi-IMT）干预与假性低强度 IMT（Lo-IMT）对照组对断奶困难患者在纳入 28 天后的断奶效果、呼吸肌和肺功能的影响：两组患者均每天接受 IMT 治疗，直至成功断奶或最长 28 天。Hi-IMT组（n=44，61%为男性，57±15岁）在最大吸气压力（PImax）为30-50%的外部负荷下从残余量开始进行最大吸气，而对照组（n=46，52%为男性，60±12岁）在PImax≤10%的负荷下进行最大吸气：两组的训练坚持率（完成/计划训练）相当（Hi-IMT：77±20%，Lo-IMT：72±17%，P=0.25）。两组的断奶成功率（Hi-IMT：64%，Lo-IMT：76%；P=0.43）和断奶持续时间（Hi-IMT：45±48 天，Lo-IMT：37±26 天，P=0.33）相似。两组 PImax 的改善情况相似（Hi-IMT：+15cmH2O [95%CI：9；20]，Lo-IMT：+14cmH2O [95%CI：9；19]，P=0.72）。Hi-IMT组比Lo-IMT组的用力肺活量改善更大（Hi-IMT：+0.33L [95%CI：0.22；0.43]，Lo-IMT：+0.16L [95%CI：0.07；0.25]，P=0.04）：结论：在高度遵守方案的情况下，高强度 IMT 和假性低强度 IMT 都能带来相似的断奶成功率和最大吸气肌力的明显改善。临床试验注册请访问 www.Clinicaltrials: gov，ID：NCT03240263。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of respiratory and critical care medicine 医学-呼吸系统

CiteScore

27.30

自引率

4.50%

发文量

1313

审稿时长

3-6 weeks

期刊介绍： The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.