背景:吸气肌肉训练(IMT)已被公认为在重症监护环境中对抗吸气肌肉无力的安全选择。它可以改善吸气肌肉力量并减少断奶时间,但缺乏对最佳训练方案的了解会导致结果不一致。我们提出了这样的假设,即针对耐力和力量改善的创新混合强度计划可能会更有效。我们进行了一项多中心随机对照平行试验,比较了三种IMT方案的影响(低,高,和混合强度)对难以断奶的患者的吸气肌肉力量和耐力。
方法:将92例患者随机分为三组,采用不同的训练计划,每个人每天执行两次IMT程序,每周7天,从纳入到成功拔管或30天。主要结果是最大吸气压力(MIP)升高。次要结果包括作为耐力指标的峰值压力(Ppk)增加,机械通气(MV)持续时间,ICU住院时间,断奶成功定义为拔管后2天无呼吸机,再插管率和安全性。
结果:MIP增加10.8±11.9cmH2O,4.5±14.8cmH2O,混合强度(MI)为6.7±14.5cmH2O,低强度(LI),和高强度(HI)组,分别。MI组和LI组之间存在无统计学差异(平均校正差异:6.59,97.5%CI[-14.36;1.18],p=0.056);MI组和HI组之间没有差异(平均校正差异:-3.52,97.5%CI[-11.57;4.53],p=0.321)。三组间Ppk增加无显著差异。MI中观察到的断奶成功率,HI和LI组为83.7%[95%CI69.3;93.2],82.6%[95%CI61.2;95.0]和73.9%[95%CI51.6;89.8],分别。MV持续时间,ICU住院时间和再插管率具有相似的值。超过629个IMT会话,LI组6例不良事件,包括4例自发性可逆性心动过缓,可能与本研究相关.
结论:在接受侵入性MV的难以断奶的患者中,在3个不同的IMT项目中,力量和耐力进展无统计学差异.IMT在通常的护理中似乎是可行的,但一些严重的不良事件,如心动过缓,可能会促使进一步研究其对心脏系统的具体影响.试验注册Clinicaltrials.gov标识符:NCT02855619。2014年9月28日注册。
BACKGROUND: Inspiratory muscle training (IMT) is well-established as a safe option for combating inspiratory muscles weakness in the intensive care setting. It could improve inspiratory muscle strength and decrease weaning duration but a lack of knowledge on the optimal training regimen raise to inconsistent results. We made the hypothesis that an innovative mixed intensity program for both endurance and strength improvement could be more effective. We conducted a multicentre randomised controlled parallel trial comparing the impacts of three IMT protocols (low, high, and mixed intensity) on inspiratory muscle strength and endurance among difficult-to-wean patients.
METHODS: Ninety-two patients were randomly assigned to three groups with different training programs, where each performed an IMT program twice daily, 7 days per week, from inclusion until successful extubation or 30 days. The primary outcome was maximal inspiratory pressure (MIP) increase. Secondary outcomes included peak pressure (Ppk) increase as an endurance marker, mechanical ventilation (MV) duration, ICU length of stay, weaning success defined by a 2-day ventilator-free after extubation, reintubation rate and safety.
RESULTS: MIP increases were 10.8 ± 11.9 cmH2O, 4.5 ± 14.8 cmH2O, and 6.7 ± 14.5 cmH2O for the mixed intensity (MI), low intensity (LI), and high intensity (HI) groups, respectively. There was a non-statistically difference between the MI and LI groups (mean adjusted difference: 6.59, 97.5% CI [- 14.36; 1.18], p = 0.056); there was no difference between the MI and HI groups (mean adjusted difference: - 3.52, 97.5% CI [- 11.57; 4.53], p = 0.321). No significant differences in Ppk increase were observed among the three groups. Weaning success rate observed in MI, HI and LI group were 83.7% [95% CI 69.3; 93.2], 82.6% [95% CI 61.2; 95.0] and 73.9% [95% CI 51.6; 89.8], respectively. MV duration, ICU length of stay and reintubation rate had similar values. Over 629 IMT sessions, six adverse events including four spontaneously reversible bradycardia in LI group were possibly related to the study.
CONCLUSIONS: Among difficult-to-wean patients receiving invasive MV, no statistically difference was observed in strength and endurance progression across three different IMT programs. IMT appears to be feasible in usual cares, but some serious adverse events such as bradycardia could motivate further research on the specific impact on cardiac system. Trial registration Clinicaltrials.gov identifier: NCT02855619. Registered 28 September 2014.