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BRIEF INFORMATION ON RESPIRATORY MUSCLE TRAINING ARTICLE OBJECTIVE METHODOLOGY INTERVENTION MEASURES RESULTS DISCUSSION CONCLUSION STRONG POINTS LIMITATIONS REFERENCES

RESPIRATORY MUSCLE TRAINING A technique that aims to

improve function of the respiratory muscles using specific exercises.

Normally aimed at people who have Asthma, Bronchitis, Emphysema and COPD

RESPIRATORY MUSCLE TRAINING Consist of Inspiratory Muscle

Training (IMT) or Expiratory Muscle Training (EMT) or a combination of both

RESPIRATORY MUSCLE TRAINING

Responses to RMT includes: Changes in muscle fiber type Improvements in strength,

speed, power, endurance performance MIP and MEP

RESPIRATORY MUSCLE TRAINING

Training Principles Overload Specificity Reversibility

INSPIRATORY MUSCLE TRAINING TO ENHANCERECOVERY FROM MECHANICAL VENTILATION;A RANDOMIZED TRIAL

AUTHORS: Bernie M Bisset, Anne Leditschke, Teresa

Neeman, Robert Boots, Jennifer Paratz

Published on June 2, 2016

ARTICLE OBJECTIVE The objective of this research

was to see if IMT improves inspiratory muscle strength and quality of life (QOL) in patients recently weaned from invasive ( mechanical) ventilation

METHODOLOGY Participants were selected by

computer – generated random number sequence, managed by off- site administrative staff

The study was conducted at the Canberra Hospital ( located in Australia)

METHODOLOGY A second hospital was also

included (Calvary Hospital) but no patients were recruited due to failure to meet requirements

With 48 hours of successful weaning, 70 participants ( mechanically ventilated ≥ 7days) were randomized to receive IMT once daily 5 days/ week for 2 weeks with usual care or just usual care ( control group)

METHODOLOGY

IMT Group Control GroupInspiratory muscle training ( 2 weeks)

Usual physiotherapy ( respiratory treatment and mobilization)

Usual physiotherapy ( respiratory treatment and mobilization)

METHODOLOGYInclusion Criteria : Patients who are successfully weaned

from the mechanical ventilation ( > 48 hrs) and within the 7 days following the successful weaning

Patients aged ≥ 16 years who are able to provide informed consent

Patients who are alert and able to train with a Riker score of 4

METHODOLOGY EXCLUSION CRITERIA

Low neurological statusPregnantParticipation in IMT while ventilated Delirium/ agitationMedically unstableDeclined to participateImminent PalliationIntellectual disabilityUnable to communicateFacial Fractures

INTERVENTION Participants were randomized to

receive either usual care (control group) or IMT with usual care

IMT was performed using a threshold IMT – Inspiratory Muscle Trainer ( threshold IMT device HS730,Respironics, New Jersey, USA)

INTERVENTION

INTERVENTION This device was used with the

mouthpiece, or flexible connector to attach to the tracheostomy

Once a tracheostomy in situ, IMT was always performed with the cuff inflated to ensure accurate loading

INTERVENTION

INTERVENTION The physiotherapist gave an intensity

of 50% MIP for the first training set

Then quickly increase it to a tolerable intensity that allowed for the pt to complete 6th breath in a set of six breaths with 5 sets of six breaths completed each session

INTERVENTION The intensity was increased daily

by the physiotherapist by manually increasing the threshold resistance by 1-2 cm H2O

Training started on the day of enrolment and was done once daily for 2 weeks (weekdays only)

MEASURES Primary Endpoints- inspiratory

muscle strength and Inspiratory Muscle Fatigue

Secondary Endpoints- Dyspnoea, physical function and quality of life, post intensive care length of stay and in- hospital mortality

RESULTS MIP improved in both groups with

a greater increase in the IMT group than the control group – 17% in the IMT group compared to 6 % in control, p= 0.024.

No statistical value change in FRI was observed in both groups (0.03 vs 0.02, p=0.81)

RESULTS Quality of Life was greater in the

IMT group Changes in dyspnoea scores at rest

and during exercise were not statistically significant.

No significant difference in post – ICU length of stay, reintubation rate or ICU readmission

RESULTS There was a difference in

hospital mortality which was higher in the IMT group (p=0.051) with four deaths.

DISCUSSION Participants who completed 2

weeks of IMT have greater improvement in respiratory muscle strength than their counterparts

IMT group expressed improved quality of life using the EQ5D

DISCUSSION In COPD patients IMT has longer

term effects including lower rates of hospitalization over a 12 month period

The maximum setting on the device is 41cmH2O and it was impossible for 2 participants to achieve greater than 50% MIP

DISCUSSION The reasons for improved

QOL in the absence of a demonstrated effect on respiratory endurance, dyspnoea or functional level remained unclear

CONCLUSIONS IMT following successful weaningincreases IMT strength and QOL .

The researchers cannot confidently rule out an associated increase risk of in- hospital mortality

STRONG POINTS The study was approved by the Australian

Capital Territory Health Human Ethics Committee and the University of Queensland Medical Research Ethics Committee

This study was the first to demonstrate the value of IMT for patients in the postextubation period

Clear and concise Inclusion Criteria

STRONG POINTS Good reliability , inter – rater

reliability and validity of most research tools used in the research

There was researcher blinding to group allocation for MIP, QOL, Dyspnoea and physical function measurements

LIMITATIONS The physiotherapists could not be

blinded in administering IMT training to patients

Inability to demonstrate an improvement in Inspiratory Muscle Endurance in the IMT group

A lack of follow-up of primary outcomes beyond 2 weeks

LIMITATIONS Not all participants achieved

greater than 50% MIP which underestimated the effect of IMT in this research

LIMITATIONS In assessing QOL the

researchers also used SF36 questionnaire which is a lengthy questionnaire.

THE IMPORTANCE OF THIS RESEARCH This research can let PTs

understand how this specific regime of IMT may be useful adjunct to the medical management pts in post weaning period

REFERENCES Buxton, S . Cotton, L. Lowe, R. Respiratory

Muscle Training. Retrieved from http:// www.physio-pedia.com/Respiratory _Muscle_Training

Bissett, B., Boots, R., Leditschke, A., Neeman, T., Paratz. (2016). Inspiratory Muscle training to enhance recovery from mechanical ventilation : a randomized trial. Thorax Online First. 71(9) http://thorax.bmj.com/content/71/9/812.short?g=w_thorax_current_tab

THE ENDANY QUESTIONS??