Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial

Questions: Does inspiratory muscle training improve maximal inspiratory pressure in intubated older people? Does it improve breathing pattern and time to wean from mechanical ventilation? Design: Randomised trial with concealed allocation and intention-to-treat analysis. Participants: 41 elderly, intubated adults who had been mechanically ventilated for at least 48 hr in an intensive care unit. Intervention: The experimental group received usual care plus inspiratory muscle training using a threshold device, with an initial load of 30% of their maximal inspiratory pressure, increased by 10% (absolute) daily. Training was administered for 5 min, twice a day, 7 days a week from the commencement of weaning until extubation. The control group received usual care only. Outcome measures: The primary outcome was the change in maximal inspiratory pressure during the weaning period. Secondary outcomes were the weaning time (ie, from commencement of pressure support ventilation to successful extubation), and the index of Tobin (ie, respiratory rate divided by tidal volume during a 1-min spontaneous breathing trial). Results: Maximal inspiratory pressure increased significantly more in the experimental group than in the control group (MD 7.6 cmH(2)O, 95% CI 5.8 to 9.4). The index of Tobin decreased significantly more in the experimental group than in the control group (MD 8.3 br/min/L, 95% CI 2.9 to 13.7). In those who did not die or receive a tracheostomy, time to weaning was significantly shorter in the experimental group than in the control group (MD 1.7 days, 95% CI 0.4 to 3.0). Conclusions: In intubated older people, inspiratory muscle training improves maximal inspiratory pressure and the index of Tobin, with a reduced weaning time in some patients. Trial registration: NCT00922493. [Cader SA, Vale RGS, Castro JC, Bacelar SC, Biehl C, Gomes MCV, Cabrera WE, Dantas EHM (2010) Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial. Journal of Physiotherapy 56: 171-177]