Maternal and Child Health Doctoral Program, Prof. Fernando Figueira Integral Medicine Institute, Recife, Brazil; KU Leuven, Respiratory Rehabilitation and Respiratory Division, University Hospitals, Leuven, Belgium.
State University of Londrina, Department of Physiotherapy, Londrina, Brazil; KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Leuven, Belgium.
Respir Med. 2018 Jan;134:54-61. doi: 10.1016/j.rmed.2017.11.023. Epub 2017 Dec 2.
Respiratory muscle dysfunction, being a common cause of weaning failure, is strongly associated with prolonged mechanical ventilation (MV) and prolonged stay in intensive care units. Inspiratory muscle training (IMT) has been described as an important contributor to the treatment of respiratory muscle dysfunction in critically ill patients. Its effectiveness is however yet controversial.
To discuss evidence for assessment of readiness and the effectiveness of interventions for liberation from MV, with special attention to the role of IMT.
PubMed, LILACS, PEDro and Web of Science were searched for papers of assessment and treatment of patients who failed liberation from MV after at least one attempt published in English or Portuguese until June 2016.
Weaning predictors are related to weaning success (86%-100% for sensitivity and 7%-69% for specificity) and work of breathing (73%-100% for sensitivity and 56%-100% for specificity). Spontaneous breathing trials (SBT), noninvasive MV and early mobilization have been reported to improve weaning outcomes. Two modalities of IMT were identified in five selected studies: 1) adjustment of ventilator trigger sensitivity 2) inspiratory threshold loading. Both IMT training modalities promoted significant increases in respiratory muscle strength. IMT with threshold loading showed positive effect on endurance compared to control.
Methods to indentify respiratory muscle weakness in critically ill patients are feasible and described as indexes that show good accuracy. Individualized and supervised rehabilitation programs including IMT, SBT, noninvasive MV and early mobilization should be encouraged in patients with inspiratory muscle weakness.
呼吸肌功能障碍是导致撤机失败的常见原因，它与长时间机械通气（MV）和长时间入住重症监护病房密切相关。吸气肌训练（IMT）已被描述为治疗危重病患者呼吸肌功能障碍的重要手段。然而，其效果仍存在争议。
讨论评估准备情况和从 MV 中解脱干预措施的有效性，特别关注 IMT 的作用。
在 PubMed、LILACS、PEDro 和 Web of Science 上检索了 2016 年 6 月前至少有一次撤机尝试失败的患者的评估和治疗论文，语言为英语或葡萄牙语。
撤机预测因素与撤机成功相关（敏感性为 86%-100%，特异性为 7%-69%）和呼吸功相关（敏感性为 73%-100%，特异性为 56%-100%）。有研究报道，自主呼吸试验（SBT）、无创性 MV 和早期活动可改善撤机结果。在五项入选研究中发现了两种 IMT 方式：1）调整呼吸机触发灵敏度，2）吸气阈负荷。两种 IMT 训练方式都显著增加了呼吸肌力量。与对照组相比，阈负荷的 IMT 对耐力有积极影响。
在危重病患者中识别呼吸肌无力的方法是可行的，被描述为具有良好准确性的指标。在有吸气肌无力的患者中，应鼓励个体化和监督的康复计划，包括 IMT、SBT、无创性 MV 和早期活动。
