Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians

Bernie Bissett; I Anne Leditschke; Margot Green; Vince Marzano; Sarajane Collins; Frank Van Haren

doi:10.1016/j.aucc.2018.06.001

Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians

Aust Crit Care. 2019 May;32(3):249-255. doi: 10.1016/j.aucc.2018.06.001. Epub 2018 Jul 11.

Authors

Bernie Bissett¹, I Anne Leditschke², Margot Green³, Vince Marzano³, Sarajane Collins⁴, Frank Van Haren⁵

Affiliations

¹ Discipline of Physiotherapy, University of Canberra, Canberra Hospital, Canberra, Australia; Physiotherapy Department, Canberra Hospital, Canberra, Australia. Electronic address: bernie.bissett@canberra.edu.au.
² Intensive Care Unit, Mater Health, Mater Research Institute, University of Queensland, Brisbane, Australia.
³ Physiotherapy Department, Canberra Hospital, Canberra, Australia.
⁴ Intensive Care Unit, Canberra Hospital, Canberra, Australia.
⁵ Intensive Care Unit, Canberra Hospital, Canberra, Australia; School of Medicine, Australian National University, Canberra, Australia; Faculty of Health, University of Canberra, Canberra, Australia.

PMID: 30007823
DOI: 10.1016/j.aucc.2018.06.001

Abstract

Objectives: To describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU).

Background: Inspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients.

Methods: Patients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set.

Results: Using this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days' duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT.

Conclusions: This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.

Keywords: Breathing exercises; Critical care; Intensive care; Physiotherapy (techniques).

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Breathing Exercises*
Humans
Intensive Care Units*
Muscle Weakness / rehabilitation*
Respiration, Artificial / adverse effects*
Respiratory Function Tests
Respiratory Muscles / physiopathology*