Inspiratory muscle training for chronic critically ill patients: a systematic review and meta-analysis of randomized controlled trialsABSTRACT
Objective To systematically review and analyze studies investigating the efficacy and safety of inspiratory muscle training in adult chronic critically ill patients.
Methods The MEDLINE, Embase, CENTRAL, LILACS, Clinical Trials Registry, and World Health Organization databases were queried on November 24, 2022 and January 22, 2025. The review was conducted in accordance with the PRISMA guidelines. RevMan V5.4 was used to analyze mean differences or standardized mean differences and 95% confidence intervals (95%CIs) for continuous variables and risk ratios with 95%CIs for dichotomous outcomes. The primary outcomes were inspiratory muscle strength, duration of mechanical ventilation, and severe adverse events; the secondary outcomes were hospital and intensive care unit mortality, intensive care unit and hospital lengths of stay, pulmonary function, non-serious adverse events, respiratory muscle mass, and functional status.
Results Seven studies (n=390 participants) were included in the analysis. There was a significant increase in inspiratory muscle strength with inspiratory muscle training versus usual care (mean difference, -8.37; 95%CI= -15.21 to -1.52), although the certainty of evidence was very low; when compared with sham interventions, there was no significant difference (mean difference, -4.26; 95%CI= -14.05 to 5.53), also with very low certainty of evidence. The results for pulmonary function, duration of mechanical ventilation, and mortality were imprecise, with very low certainty of evidence. The available evidence also indicates the potential safety benefit of inspiratory muscle training, although the certainty of evidence remains very low. Conclusion: We identified that inspiratory muscle training may improve inspiratory muscle strength, with little to no difference on duration of mechanical ventilation, pulmonary function and severe and non-serious adverse events, when compared to sham inspiratory muscle training and usual care. However, the certainty of the evidence is very low. Evidence regarding the impact of inspiratory muscle training on intensive care unit mortality and length of stay is uncertain. Prospero database registration ID CRD42022370750.
Breathing exercises; Respiration, artificial; Tracheostomy; Critical illness; Chronic disease; Respiratory muscles; Muscle strength; Intubation, intratracheal
INTRODUCTION
Recent advancements in healthcare and the integration of cutting-edge medical technologies have markedly enhanced the survival rates of critically ill patients admitted to intensive care units (ICUs) worldwide.1,2 However, this progress has also led to a growing population of critically ill patients requiring prolonged mechanical ventilation (MV) support and other high-complexity intensive care therapies.1,3,4
Chronic critically ill patients (CCIPs) are patients who experience an ICU stay of 8 days or more, coupled with conditions like prolonged MV, tracheostomy, severe infections, extensive wounds or multiple organ failure, ischemic stroke, intracerebral hemorrhage, or traumatic brain injury.1-3,5 Prolonged MV support for CCIPs is defined as the need for more than three consecutive weeks of support with a daily duration exceeding 6h.3,6 These clinical characteristics, combined with the prolonged MV weaning process, can affect both peripheral and respiratory muscles and contribute to the suboptimal clinical and functional outcomes associated with ICU-acquired weakness (ICUAW).7-13 This condition in turn is correlated with adverse prognostic outcomes characterized by poor mental health and quality of life in family members with high morbidity and mortality.12,14 Nonetheless, and even though ICUAW is becoming more common among ICU-admitted patients, its etiology and management are not well characterized.
Chronic critically ill patients also face significant challenges transitioning from the ICU to home settings, particularly in terms of functional recovery and impact on family members’ mental health and quality of life outcomes.13,15 Inspiratory muscle training (IMT) is recognized as an effective rehabilitation strategy to mitigate respiratory muscle loss and weakness in ICU patients and prevent ICUAW in respiratory muscles.16-18 Inspiratory muscle training specifically focuses on enhancing the strength and endurance of respiratory muscles, including the diaphragm and accessory muscles, and aims to alleviate symptoms such as dyspnea and improve the success rate of the weaning process.19-21 Although IMT has been demonstrated to be safe, feasible, and well tolerated in the general CCIP population, there is still considerable uncertainty in the literature regarding the prescription of IMT for these patients, mostly stemming from the wide variability in the load, frequency, and duration of IMT protocols, which can significantly affect outcomes.20,22
Thus, although numerous studies have demonstrated the efficacy of IMT for mechanically ventilated patients, its relevance for CCIPs remains unclear.
OBJECTIVE
The purpose of this review was to evaluate the effectiveness of inspiratory muscle training for chronic critically ill patients and assess whether inspiratory muscle training is associated with enhancement of muscle strength in chronic critically ill patients.
METHODS
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines,23,24 and followed the methodological recommendations of the Cochrane Collaboration Handbook.25
An initial search of the MEDLINE, Embase, CENTRAL, and LILACS databases was performed on November 24, 2022, with an updated search on January 22, 2025 (Tables 1S to 4S, Supplementary Material). Additionally, searches were also performed on the ClinicalTrials.gov registry website and the World Health Organization (WHO) International Clinical Trials Registry Platform to identify ‘ongoing’ and ‘unpublished’ studies (Tables 5S to 6S, Supplementary Material). There were no restrictions on language, date, or publication status. Only parallel randomized controlled trials (RCTs) were included; quasi-randomized trials were not included in this review.
The eligibility criteria were established using the Population, Intervention, Comparator, and Outcome (PICO) approach26 as follows: (P) population: adult patients meeting the criteria for CCIPs; (I) intervention: IMT, regardless of type, frequency, and duration; (C) comparator: general rehabilitation; usual or standard care; or no intervention; and (O) outcome: inspiratory muscle strength; MV duration; number of severe adverse events; ICU and hospital mortality; ICU and hospital length of stay; pulmonary function; non-serious adverse events; respiratory muscle mass/thickness; and functional status. Records from each individual study were collated so that each study was included only once.
Two investigators independently screened all titles and abstracts retrieved through the systematic search. A third investigator was consulted to resolve potential disagreements regarding the included articles if necessary. Thereafter, two investigators reviewed the articles for full-text assessment. Disagreements regarding eligibility were resolved through discussion.
The primary outcomes were inspiratory muscle strength, MV duration, and the number of severe adverse events. The secondary outcomes were ICU and hospital mortality, ICU and hospital length of stay, pulmonary function (e.g., total lung capacity and forced vital capacity), non-serious adverse events (e.g., respiratory muscle fatigue during or after the training as assessed based on clinical criteria such as increased respiratory rate, use of accessory respiratory muscles, and decrease in oxygen saturation), respiratory muscle mass/thickness (assessed based examinations such as point-of-care ultrasound assessment), and functional status (assessed based on criteria such as Perme ICU mobility score, ICU Mobility Scale score, Surgical ICU Optimal Mobilization Score, six-minute walking test result, thirty-second sit-to-stand test result).
Study characteristics and outcome data were independently extracted by two investigators and reviewed by a third investigator using a pre-defined data collection form. To characterize and assess the similarities of participants among included studies, we extracted and assessed details of experimental and control interventions, ranges of outcome measures, and assessment time points for each study.
The risk of bias of the outcomes was assessed using the Cochrane Risk of Bias 2 (RoB2) tool for randomized trials.26,27 Risk of bias was assessed in terms of five domains: (i) randomization process, (ii) deviations from intended interventions, (iii) missing outcome data, (iv) measurement of the outcome, and (v) selection of the reported result. For all included studies, a score indicating the level of risk of bias (‘low’, ‘some concerns’, or ‘high’) was assigned for each domain.
Mean differences (MDs) or standardized mean differences (SMDs) and 95% confidence intervals (95%CIs) were used to analyze continuous variables. For dichotomous outcomes, we calculated risk ratios (RRs) and 95%CIs. When possible, skewed data were adjusted for mean and standard deviation using Wan’s method and the Review Manager (RevMan) Calculator.28 When substantial heterogeneity was identified (I2 ≥ 50%), we conducted a pre-defined subgroup analysis for the number of IMT sessions.
RevMan version 5.4.1. (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2020) was used for all analyses. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess and summarize the overall certainty of the current evidence for each outcome29 using the GRADEpro Guideline Development Tool.30
RESULTS
A total of 3,531 records were identified in the initial search, and 2,890 unique records were screened after excluding duplicates. Following the assessment of titles, abstracts, and full-texts, 16 records originating from 7 distinct studies (n=390 participants)31-37 were included in the systematic review (Figure 1). The baseline characteristics of each included study are summarized in Table 1 and Tables 7S to 8S, Supplementary Material. The included studies were published between 2011 and 2022 and conducted in three countries: Brazil (n=5),31,32,34,35,37 the United States of America (n=1),33 and Belgium (n=1).36 The sample sizes ranged from 10 to 101 participants. Three studies31,33,34 utilized the Threshold® Inspiratory Muscle Trainer device and four studies32,35-37 employed the POWERbreathe® device. The initial training load intensity was between 20 and 40% of maximum inspiratory pressure (MIP).
Four studies31,33,36,37 described details of the randomization process, deviations from intended interventions, and missing outcome data. However, three studies32,34,35) were judged as having a ‘high risk’ of bias for the inspiratory muscle strength outcome due to insufficient information on the randomization process and lack of information regarding assessor blinding. Three studies31,34,35 were judged as having a ‘some concerns’ level risk of bias for the following outcomes: MV duration, number of severe adverse events, ICU mortality, ICU length of stay, and non-serious adverse events. The overall risk of bias in the included studies is summarized in Figure 1S, Supplementary Material.
Four studies31,32,34,37 investigating inspiratory muscle strength were included in the quantitative analysis (Figure 2). The IMT group had a higher increase in the inspiratory muscle strength than usual care group (MD, -8.37; 95%CI= -15.21 to -1.52), with very low certainty of evidence. The certainty of evidence was double-downgraded due to serious imprecision, a small number of participants, and moderate inconsistency (I2 = 39%) (Table 9S, Supplementary Material). Moderate heterogeneity was found and explored through subgroup analyses focusing on the number of repetitions per session (Figure 2S, Supplementary Material). The effect was not significantly different when comparing the IMT and usual care groups, and low heterogeneity (I2 = 0%) was noted. A significant increase in inspiratory muscle strength was observed for participants performing more than 50 repetitions per IMT session (MD, -10.88; 95%CI= -22.03 to 0.26), although considerable heterogeneity (I2 = 75%) was noted.
Two studies (33,36) compared IMT with sham interventions and did not find significant differences in MIP (MD, -4.26; 95%CI= -14.05 to 5.53) with moderate heterogeneity (I2 = 54%) and very low certainty of evidence (Figure 3). The certainty of evidence was downgraded due to imprecision, few participants, and inconsistency (Table 9S, Supplementary Material). In one study,33 a short intervention period characterized by a higher number of repetitions per session was used, with a favorable trend to the IMT group (Figure 3). In contrast, another study36 reported the longest duration of intervention, ranging up to 28 days or successful weaning from MV, and the results showed a large confidence interval (Figure 3).
Three studies31,34,37 investigated the duration of MV. Quantitative analysis was not performed because of data heterogeneity, especially regarding the unit of measure (days or hours) and the final cutoff point used to determine the total duration of MV. The certainty of evidence was classified as very low and double-downgraded because of very serious imprecision (Table 9S, Supplemantary Material). One study37 (n=104 participants) investigated two interventions (automatic and manual IMT) in addition to the control treatment and reported a decrease in MV duration (days) (median [IQR]: usual care, 24.5 [15.75-32.25]; automatic IMT, 18 [15.25-26.50]; manual IMT, 14.5 [12-21.75];37 the authors measured MV duration from the time of tracheostomy until continuous spontaneous breathing for 48h.37 Two other studies reported a slight difference31 and no difference34 in the duration of MV when comparing IMT with usual care.
Two studies31,33 assessed the safety of IMT, although both used a different comparator (usual care31 and sham).33 The details of recording and registering adverse events were reported in only one study,31 which focused on adverse events related to hemodynamic changes. None of the studies reported any evidence of adverse events related to the use of IMT for CCIPs. Despite this positive trend, the sample size was small, and the results should therefore be interpreted with caution. The certainty of the evidence was very low, and we doubled downgraded it because of very serious imprecision (Table 9S, Supplementary Material).
Four studies31-33,37 evaluated mortality with different follow-up periods ranging from 7 days to 1 year. Two studies35,37 reported length of stay, one study35 did not find any differences between the IMT and Control Groups whereas the other38 showed a small difference between the automatic IMT and Control Groups. However, owing to the short period of the IMT intervention compared to the total duration of hospital care, these results may not reflect the actual effects of the intervention on mortality and length of stay, and thus, a quantitative analysis was not performed for these outcomes. Only one study36 evaluated pulmonary function, based on forced vital capacity, and reported improvement in the IMT group when compared to the Control Group, although the certainty of evidence was uncertain due to imprecision of the results (Table 9S, Suplemmentary Material). Some outcomes specified in the registered protocol, specifically hospital mortality, length of hospital stay, respiratory muscle mass/thickness, and functional status, were not assessed in any of the studies included in this review.
DISCUSSION
To the best of our knowledge, this is the first study to review the effects of IMT on CCIPs. This systematic review and meta-analysis showed that IMT may enhance inspiratory muscle strength, presenting preliminary results of reduced MV duration and improved pulmonary function, with no reports of severe or non-serious adverse events. However, evidence regarding the impact of IMT on ICU mortality and length of stay is uncertain owing to the imprecision of and short duration of interventions in the included studies.
Inspiratory muscle weakness is a common complication among CCIPs. It is considered a risk factor for a prolonged MV weaning process and may increase the incidence of ventilator-associated pneumonia, predisposing patients to poor clinical and physical outcomes.2,39,40 The results of this systematic review showed that IMT slightly increased inspiratory muscle strength in CCIPs when compared to usual care patients, with no significant difference between the IMT and sham groups. A previous review also reported a moderate yet potentially impactful enhancement of inspiratory muscle strength,22 but there was high heterogeneity among the included studies due to considerable variability between IMT protocols with regard to dose, intensity, and frequency.19,41,42 The present review also found improvements in inspiratory muscle strength in patients who performed more repetitions per session. Most of the studies included in this review employed inspiratory threshold loading to address IMT protocols. The literature also supports the hypothesis that IMT can improve inspiratory muscle strength, exercise performance capacity, and quality of life in patients with chronic conditions such as chronic obstructive pulmonary disease,43 heart failure,44 asthma,45 and cystic fibrosis.46 Additionally, these benefits have been reported in patients with spinal cord injury,47 multiple sclerosis,48 and neuromuscular diseases.49 For patients undergoing elective open cardiac surgery, IMT improved inspiratory muscle strength and reduced the risk of postoperative pulmonary complications and the length of hospital stay.50
A reduction in MV duration has also been reported in a previous systematic review that included patients who underwent IMT sessions while being admitted to the ICU.22 Although the treatment effect did not persist after excluding studies with a ‘serious risk of bias’, IMT was associated with a reduction in duration of weaning from MV support.22 Our findings also corroborate those of a previous review that reported no clear evidence regarding the effects of IMT on MV duration. Additionally, none of the studies included in this review reported the occurrence of adverse events (mild, moderate, or severe), and previous literature corroborates these findings, as they also report a low incidence of adverse events in patients who underwent IMT. Although infrequent, the commonly reported complications of IMT sessions in these studies are bradycardia, syncope, paradoxical breathing, tachypnea, desaturation, and hemodynamic instability.22 The feasibility and tolerance of IMT applications have been demonstrated;19,21,22 however, the evidence remains uncertain for CCIPs.
This systematic review and meta-analysis provided important insights and contributions to literature by presenting evidence regarding the effectiveness of IMT for CCIPs. The strengths of this review include clearly defined search criteria and methodology following guidelines regarding best practices for systematic review. By ensuring high methodological rigor—employing a sensitive and broad search strategy and independent selection, extraction, and analysis of data by two investigators), we considerably reduced the chances of excluding any relevant study. Additionally, information on ‘ongoing studies’ is also presented to help provide readers a more complete overview of this topic.
However, this review has some limitations. First, the certainty of evidence was judged as ‘very low’ due to imprecision and ‘moderate’ to ‘high’ risk of bias for most of the outcomes assessed. The overall certainty of the evidence in the included studies was compromised because of the absence of transparency and missing information on the randomization methods used. Second, the short intervention and follow-up periods and heterogeneity among IMT protocols may have affected the findings and limited the possibility of performing a meta-analysis. Third, in-hospital mortality and hospital stay, muscle mass, and functional status were not assessed as outcomes in any of the included studies, although these were planned for in the systematic review protocol. Fourth, due to the small number of included studies, the findings of this review should be interpreted with caution. Therefore, future RCTs should focus on extending the duration of IMT interventions and determining the effects of IMT on mortality, length of hospital stay, functional status, and respiratory muscle mass.
In summary, our findings suggest that IMT for CCIPs is associated with increased inspiratory muscle strength when the number of repetitions is appropriately high; furthermore, IMT is not associated with adverse events and may reduce MV duration. However, the certainty of the evidence remains low, and future studies are needed to investigate the benefits of respiratory muscle training for CCIPs, focusing on the dose, duration, and intensity of training.
ACKNOWLEDGMENTS
The authors acknowledge Ana Carolina Pereira Nunes Pinto, Bianca Maria Schneider Pereira Garcia, and Emanuel dos Santos Pereira for their support with conducting this review. We also especially acknowledge Dr. Thiago Domingos Corrêa for providing administrative support and Helena Spalic for the valuable contribution to proofreading the manuscript.
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SUPPLEMENTARY MATERIAL
Inspiratory muscle training for chronic critically ill patients: a systematic review and meta-analysis of randomized controlled trials
Gustavo Rodrigues das Chagas, Aléxia Gabriela da Silva Vieira, Jamile Caroline Garbuglio de Araújo, Raquel Afonso Caserta Eid, Caroline Gomes Mól, Ricardo Kenji Nawa
DOI: 10.31744/einstein_journal/2025RW1134
REFERENCES
1. ClinicalTrials.gov. Identifier: NCT04658498. Improving Our Understanding of Respiratory Muscle Training to Facilitate Weaning From Mechanical Ventilation in the ICU (TrainToWean). Bethesda (MD): National Library of Medicine (US); 2024 [cited 2024 Nov 10]. Available from: https://clinicaltrials.gov/study/NCT04658498
2. ClinicalTrials.gov. Identifier: NCT04347317. Can High Intensity Inspiratory Muscle Training Improve Inspiratory Muscle Strength and Accelerate Weaning in Medical Patients With Difficulty on Weaning?. Bethesda (MD): National Library of Medicine (US); 2021 [cited 2024 Nov 10]. Available from: https://clinicaltrials.gov/study/NCT04347317?term=NCT04347317&rank=1
3. ClinicalTrials.gov. Identifier: NCT03758573. Effectiveness Inspirational Muscle Training (IMTversusMV). Bethesda (MD): National Library of Medicine (US); 2023 [cited 2024 Nov 10]. Available from: https://clinicaltrials.gov/study/NCT03758573?term=NCT03758573&rank=1
4. ISRCTN Registry. ISRCTN15425727. Comparison of the effectiveness of two different respiratory exercise training methods in prolonged ventilated patients. Ireland: ISRCTN Registry; 2021 [cited 2024 Nov 10]. Available from: https://www.isrctn.com/ISRCTN15425727
5. ClinicalTrials.gov. Identifier: NCT03240363. Inspiratory Muscle Training in Difficult to Wean Patients. Bethesda (MD): National Library of Medicine (US); 2024 [cited 2024 Nov 10]. Available from: https://clinicaltrials.gov/study/NC T03240263?term=NCT03240263&rank=1
6. ClinicalTrials.gov. Identifier: NCT0 2003053. A Randomized, Controlled Trial of Inspiratory Muscle Training (IMT)in the ICU and CCU. Bethesda (MD): National Library of Medicine (US); 2018 [cited 2024 Nov 10]. Available from: https://clinicaltrials.gov/study/NCT02003053?term=NCT02003053&rank=1
REFERENCES
1. Condessa RL, Brauner JS, Saul AL, Baptista M, Silva AC, Vieira SR. Inspiratory muscle training did not accelerate weaning from mechanical ventilation but did improve tidal volume and maximal respiratory pressures: a randomised trial. J Physiother. 2013;59(2):101-7.
2. Roceto Ratti LD, Marques Tonella R, Castilho de Figueir do L, Bredda Saad IA, Eiras Falcão AL, Martins de Oliveira PP. Inspiratory Muscle Training Strategies in Tracheostomized Critically Ill Individuals. Respir Care. 2022;67(8):939-48.
AAA: abdominal aortic aneurysm; ARDS: acute respiratory distress syndrome; ARF: acute respiratory failure; bpm: beats per minute; COPD: chronic obstructive pulmonary disease; CPR: cardiopulmonary resuscitation; CRA: cardiorespiratory arrest; CVA: cerebral vascular accident; GI: gastrointestinal; Hb: hemoglobin; HF: heart failure; HR: heart rate; ICU: intensive care unit; LOS: length of stay; Mb: myoglobin; MBP: mean blood pressure; MEP: maximum expiratory pressure; MI: myocardial infarct; MIP: maximum inspiratory pressure; MV: mechanical ventilation; neo: neoplasm; Post-op: postoperative; RR: respiratory rate; RSBI: rapid shallow breathing index; SAPS: simplified acute physiology score; SBP: systolic blood pressure; SD: standard deviation; SIMV: synchronized intermittent mandatory ventilation; T: temperature; TBI: traumatic brain injury; TCT: tracheostomy; Vt: tidal volume; y: years.
REFERENCES
1. Condessa RL, Brauner JS, Saul AL, Baptista M, Silva AC, Vieira SR. Inspiratory muscle training did not accelerate weaning from mechanical ventilation but did improve tidal volume and maximal respiratory pressures: a randomised trial. J Physiother. 2013;59(2):101-7.
2. da Silva Guimarães B, de Souza LC, Cordeiro HF, Regis TL, Leite CA, Puga FP, et al. Inspiratory Muscle Training With an Electronic Resistive Loading Device Improves Prolonged Weaning Outcomes in a Randomized Controlled Trial. Crit Care Med. 2021;49(4):589-97.
3. Martin AD, Smith BK, Davenport PD, Harman E, Gonzalez-Rothi RJ, Baz M, et al. Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Crit Care. 2011;15(2):R84.
4. Pascotini FD, Denardi C, Nunes GO, Trvisan ME, Antunes VD. Treinamento muscular respiratório em pacientes em desmame da ventilação mecânica. ABCS Health Sci. 2014;39(1):12-6.
5. Melo PF, Da Silva V, Vieira L, Lima L, Lira A, Silva PE, et al. High Intensity Inspiratory Muscle Training in Patients with Traumatic Brain Injury Under Mechanical Ventilation: Preliminary Results of a Randomized Controlled Trial. In: A104 Critical Care: improving ICU exercise, rehabilitation, recovery, and survivorship. American Thoracic Society; 2017 May 19-24. Washington, DC. p. A2749-A2749. (American Thoracic Society International Conference Abstracts). [cited 2024 Nov 11]. Available from: https://www.atsjournals.org/doi/epdf/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A2749?role=tab
6. Van Hollebeke M, Poddighe D, Clerckx B, Muller J, Hermans G, Gosselink R, et al. High-Intensity Inspiratory Muscle Training Improves Scalene and Sternocleidomastoid Muscle Oxygenation Parameters in Patients With Weaning Difficulties: A Randomized Controlled Trial. Front Physiol. 2022;13:786575.
7. Roceto Ratti LD, Marques Tonella R, Castilho de Figueir do L, Bredda Saad IA, Eiras Falcão AL, Martins de Oliveira PP. Inspiratory Muscle Training Strategies in Tracheostomized Critically Ill Individuals. Respir Care. 2022;67(8):939-48.
BIPAP: bilevel positive airway pressure ; CPAP: continuous positive airway pressure; ETT: endotracheal tube; IMT: inspiratory muscle training; Con: Control; MBP: mean blood pressure; MIP: maximum inspiratory pressure; MV: mechanical ventilation; NA: not applicable; NAVA: neurally adjusted ventilatory assist; NR: not reported; Obs: observation; PEP: positive expiratory pressure; PSV: pressure support ventilation; rep: repetitions; RR: respiratory rate; RP: respiratory physiotherapist; SaO2: arterial oxygen saturation; TCT: tracheostomy.
REFERENCES
1. Condessa RL, Brauner JS, Saul AL, Baptista M, Silva AC, Vieira SR. Inspiratory muscle training did not accelerate weaning from mechanical ventilation but did improve tidal volume and maximal respiratory pressures: a randomised trial. J Physiother. 2013;59(2):101-7.
2. da Silva Guimarães B, de Souza LC, Cordeiro HF, Regis TL, Leite CA, Puga FP, et al. Inspiratory Muscle Training With an Electronic Resistive Loading Device Improves Prolonged Weaning Outcomes in a Randomized Controlled Trial. Crit Care Med. 2021;49(4):589-97.
3. Martin AD, Smith BK, Davenport PD, Harman E, Gonzalez-Rothi RJ, Baz M, et al. Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Crit Care. 2011;15(2):R84.
4. Pascotini FD, Denardi C, Nunes GO, Trvisan ME, Antunes VD. Treinamento muscular respiratório em pacientes em desmame da ventilação mecânica. ABCS Health Sci. 2014;39(1):12-6.
5. Melo PF, Da Silva V, Vieira L, Lima L, Lira A, Silva PE, et al. High Intensity Inspiratory Muscle Training in Patients with Traumatic Brain Injury Under Mechanical Ventilation: Preliminary Results of a Randomized Controlled Trial. In: A104 Critical Care: improving ICU exercise, rehabilitation, recovery, and survivorship. American Thoracic Society; 2017 May 19-24. Washington, DC. p. A2749-A2749. (American Thoracic Society International Conference Abstracts). [cited 2024 Nov 11]. Available from: https://www.atsjournals.org/doi/epdf/10.1164/ajrccm-conference.2017.195.1_MeetingAbstracts.A2749?role=tab
6. Van Hollebeke M, Poddighe D, Clerckx B, Muller J, Hermans G, Gosselink R, et al. High-Intensity Inspiratory Muscle Training Improves Scalene and Sternocleidomastoid Muscle Oxygenation Parameters in Patients With Weaning Difficulties: A Randomized Controlled Trial. Front Physiol. 2022;13:786575.
7. Roceto Ratti LD, Marques Tonella R, Castilho de Figueir do L, Bredda Saad IA, Eiras Falcão AL, Martins de Oliveira PP. Inspiratory Muscle Training Strategies in Tracheostomized Critically Ill Individuals. Respir Care. 2022;67(8):939-48.
REFERENCES
1. Shosholcheva M, Jankulovski N, Kartalov A, Kuzmanovska B. Abstract PR127: Early Physical Rehabilitation Improves Outcome At Mechanical Ventilated Patients. Anesth Anal. 2016;23(3S):168.
2. Shrestha BK, Qutob HF, Berry M, Files DC, Dhar S, Bowton D, et al. Feasibility and safety of inspiratory muscle training in critically ill intubated patients. Am J Respir Crit Care Med. 2014;189:A3882.
3. Pascotini FD, Denardi C, Nunes GO, Trvisan ME, Antunes VD. Treinamento muscular respiratório em pacientes em desmame da ventilação mecânica. ABCS Health Sci. 2014;39(1):12-6.
4. Martin AD, Smith BK, Davenport PD, Harman E, Gonzalez-Rothi RJ, Baz M, et al. Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Crit Care. 2011;15(2):R84.
Edited by
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Associate Editor:
Luciano Cesar Pontes de Azevedo Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, SP, Brazil ORCID: https://orcid.org/0000-0001-6759-3910
Publication Dates
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Publication in this collection
18 July 2025 -
Date of issue
2025
History
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Received
28 Mar 2024 -
Accepted
04 Oct 2024
CENTRAL: Cochrane Central Register of Controlled Trials; EMBASE: Excerpta Medica dataBASE; MEDLINE: Medical Literature Analysis and Retrieval System Online; PICO: Patient Intervention Comparator Outcome.
95%CI: 95%confidence interval; IMT: inspiratory muscle training; SD: standard deviation.
95% CI: 95% confidence interval; IMT: inspiratory muscle training; SD: standard deviation.
D1: randomization process; D2: deviations from the intended interventions; D3: missing outcome data; D4: measurement of the outcome; D5: selection of the reported result; ICU: intensive care unit; IMT: inspiratory muscle training.
95%CI: 95% confidence interval; IMT: inspiratory muscle training; SD: standard deviation.