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Inspiratory muscle rehabilitation in critically ill adults a systematic review and meta-analysis

Vorona, Stefannie; Umberto, Sabatini; Al-Maqbali, Sulaiman; Bertoni, Michele; Dres, Martin; Bissett, Bernie M; Van Haren, Frank; Daniel Martin, A; Urrea, Cristian; Brace, Deborah; Parotto, Martin

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Rationale: Respiratory muscle weakness is common in critically ill patients; the role of targeted inspiratory muscle training (IMT) in intensive care unit rehabilitation strategies remains poorly defined. Objectives: The primary objective of the present study was to describe the range and tolerability of published methods for IMT. The secondary objectives were to determine whether IMT improves respiratory muscle strength and clinical outcomes in critically ill patients. Methods: We conducted a...[Show more]

dc.contributor.authorVorona, Stefannie
dc.contributor.authorUmberto, Sabatini
dc.contributor.authorAl-Maqbali, Sulaiman
dc.contributor.authorBertoni, Michele
dc.contributor.authorDres, Martin
dc.contributor.authorBissett, Bernie M
dc.contributor.authorVan Haren, Frank
dc.contributor.authorDaniel Martin, A
dc.contributor.authorUrrea, Cristian
dc.contributor.authorBrace, Deborah
dc.contributor.authorParotto, Martin
dc.date.accessioned2019-08-01T05:34:45Z
dc.date.available2019-08-01T05:34:45Z
dc.identifier.issn2325-6621
dc.identifier.urihttp://hdl.handle.net/1885/164880
dc.description.abstractRationale: Respiratory muscle weakness is common in critically ill patients; the role of targeted inspiratory muscle training (IMT) in intensive care unit rehabilitation strategies remains poorly defined. Objectives: The primary objective of the present study was to describe the range and tolerability of published methods for IMT. The secondary objectives were to determine whether IMT improves respiratory muscle strength and clinical outcomes in critically ill patients. Methods: We conducted a systematic review to identify randomized and nonrandomized studies of physical rehabilitation interventions intended to strengthen the respiratory muscles in critically ill adults. We searched the MEDLINE, Embase, HealthSTAR, CINAHL, and CENTRAL databases (inception to September Week 3, 2017) and conference proceedings (2012 to 2017). Data were independently extracted by two authors and collected on a standardized report form. Results: A total of 28 studies (N = 1,185 patients) were included. IMT was initiated during early mechanical ventilation (8 studies), after patients proved difficult to wean (14 studies), or after extubation (3 studies), and 3 other studies did not report exact timing. Threshold loading was the most common technique; 13 studies employed strength training regimens, 11 studies employed endurance training regimens, and 4 could not be classified. IMT was feasible, and there were few adverse events during IMT sessions (nine studies; median, 0%; interquartile range, 0-0%). In randomized trials (n = 20), IMT improved maximal inspiratory pressure compared with control (15 trials; mean increase, 6 cm H2O; 95% confidence interval [CI], 5-8 cm H2O; pooled relative ratio of means, 1.19; 95% CI, 1.14-1.25) and maximal expiratory pressure (4 trials; mean increase, 9 cm H2O; 95% CI, 5-14 cm H2O). IMT was associated with a shorter duration of ventilation (nine trials; mean difference, 4.1 d; 95% CI, 0.8-7.4 d) and a shorter duration of weaning (eight trials; mean difference, 2.3 d; 95% CI, 0.7-4.0 d), but confidence in these pooled estimates was low owing to methodological limitations, including substantial statistical and methodological heterogeneity. Conclusions: Most studies of IMT in critically ill patients have employed inspiratory threshold loading. IMT is feasible and well tolerated in critically ill patients and improves both inspiratory and expiratory muscle strength. The impact of IMT on clinical outcomes requires future confirmation.
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherAmerican Thoracic Society
dc.rights© 2018 by the American Thoracic Society
dc.sourceAnnals of the American Thoracic Society
dc.titleInspiratory muscle rehabilitation in critically ill adults a systematic review and meta-analysis
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume15
dc.date.issued2018-06
local.identifier.absfor110310 - Intensive Care
local.identifier.ariespublicationu5234101xPUB71
local.publisher.urlhttps://www.thoracic.org/
local.type.statusPublished Version
local.contributor.affiliationVorona, Stefannie, University Health Network and Mount Sinai Hospital
local.contributor.affiliationUmberto, Sabatini, Division of Respirology, Department of Medicine
local.contributor.affiliationAl-Maqbali, Sulaiman, Division of Respirology, Department of Medicine
local.contributor.affiliationBertoni, Michele, Spedali Civili Di Brescia, Department of Anesthesiology
local.contributor.affiliationDres, Martin, University of Toronto
local.contributor.affiliationBissett, Bernie M, Canberra Hospital
local.contributor.affiliationVan Haren, Frank, College of Health and Medicine, ANU
local.contributor.affiliationDaniel Martin, A, University of Florida
local.contributor.affiliationUrrea, Cristian, Division of Respirology, Department of Medicine
local.contributor.affiliationBrace, Deborah, Division of Respirology, Department of Medicine
local.contributor.affiliationParotto, Martin, Interdepartmental Division of Critical Care Medicine
local.bibliographicCitation.issue6
local.bibliographicCitation.startpage735
local.bibliographicCitation.lastpage744
local.identifier.doi10.1513/AnnalsATS.201712-961OC
local.identifier.absseo920199 - Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified
dc.date.updated2019-03-31T07:24:12Z
local.identifier.scopusID2-s2.0-85048107050
dcterms.accessRightsOpen Access
dc.provenancehttps://www.atsjournals.org/general/author..." Deposit in centralized repositories (except for PubMed Central, where ATS will submit on the authors' behalf), as mandated by funder or institution, one year after initial publication" from the publisher site (as at 1/08/19).
CollectionsANU Research Publications

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