This is a journal article critique on a research which is entitled " INSPIRATORY MUSCLE TRAINING TO ENHANCE RECOVERY FROM MECHANICAL VENTILATION; A RANDOMIZED TRIAL"
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Respiratory muscle training...
1.
2. BRIEF INFORMATION ON RESPIRATORY MUSCLE TRAINING
ARTICLE OBJECTIVE
METHODOLOGY
INTERVENTION
MEASURES
RESULTS
DISCUSSION
CONCLUSION
STRONG POINTS
LIMITATIONS
REFERENCES
3. 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
4. RESPIRATORY MUSCLE TRAINING
Consist of Inspiratory Muscle
Training (IMT) or Expiratory Muscle
Training (EMT) or a combination of
both
5. RESPIRATORY MUSCLE TRAINING
Responses to RMT includes:
Changes in muscle fiber type
Improvements in strength, speed,
power, endurance performance MIP
and MEP
7. INSPIRATORY MUSCLE TRAINING TO ENHANCE
RECOVERY FROM MECHANICAL VENTILATION;
A RANDOMIZED TRIAL
AUTHORS: Bernie M Bisset, Anne Leditschke,
Teresa
Neeman, Robert Boots, Jennifer Paratz
Published on June 2, 2016
8. 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
9. 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)
10. METHODOLOGY
A second hospital was also
included (Calvary Hospital) but no
patients were recruited due to
failure to meet requirements
11. 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)
12. METHODOLOGY
IMT Group Control Group
Inspiratory muscle training ( 2
weeks)
Usual physiotherapy ( respiratory
treatment and mobilization)
Usual physiotherapy ( respiratory
treatment and mobilization)
13. METHODOLOGY
Inclusion 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
14. METHODOLOGY
EXCLUSION CRITERIA
Low neurological status
Pregnant
Participation in IMT while ventilated
Delirium/ agitation
Medically unstable
Declined to participate
Imminent Palliation
Intellectual disability
Unable to communicate
Facial Fractures
15. 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)
17. 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
19. 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
20. 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)
21. 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
22. 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)
23. 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
24. RESULTS
There was a difference in hospital
mortality which was higher in the
IMT group (p=0.051) with four
deaths.
25. 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
26. 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
27. DISCUSSION
The reasons for improved QOL
in the absence of a
demonstrated effect on
respiratory endurance,
dyspnoea or functional level
remained unclear
28. CONCLUSIONS
IMT following successful weaning
increases IMT strength and QOL .
The researchers cannot confidently
rule out an associated increase risk
of in- hospital mortality
29. 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
30. 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
31. 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
34. 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
35. 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
Consist of series of execises, breathing to increase endurance and improve respiration. Many people adopt RMT as part of their sports training to strengthen muscles used for breathing
Increase in muscle fibers
Overload – Increasing the intensity, duration and frequency overtime to increase muscle strength
Specificity - strength - respiratory muscles respond to high-load, low-frequency load with increased strength
Reversibility - respiratory muscles respond in a similar way to other muscles when training stimulus is removed. Most of the losses occur within 2-3 months of cessation of training.
Usual care includes : assisted mobilization, secretion clearance techniques, deep breathing exercises without a resistance device and UL and LL exercises
Usual care includes : assisted mobilization, secretion clearance techniques ( PEP) , deep breathing exercises without a resistance device and UL and LL exercises
Riker Score ranges from 1 being unarousable to 7 being Dangerous Agitation – trying to remove catheters, striking at staff .Riker score of 4 is Calm, easily arousable , follows commands
1. CVA, TBI
The device was use with a mouthpiece or a flexible connector if required to attach to a tracheostomy
Primary Endpoints – was done after 2 weeks Inspiratory Muscle strength was assessed as MIP and measured using MicroRPM Respiratory Pressure Meter
Inspiratory Muscle Fatigue – Fatigue Resistant Index
Dyspnoea was measured using the Modified Borg Dyspnoea Scale
2 during the 2 week intervention period and two following the intervention period.
EQ5D - Mobilty, Self- Care, Usual Activities, Pain/ Discomfort, Anxiety and Depression.
Therefore IMT in postextubation period period as ongoing effects and should be assessed further
Due to the fact that duration of training was insufficient to measure improvement in endurance
in which one of the challenges in ICU outcome research is the effect of cognitive impairments and fatigue of pts to complete lengthy QOL assessment tools