Discipline of Physiotherapy, University of Canberra, Canberra Hospital, Canberra, Australia; Physiotherapy Department, Canberra Hospital, Canberra, Australia.
Intensive Care Unit, Mater Health, Mater Research Institute, University of Queensland, Brisbane, Australia.
Aust Crit Care. 2019 May;32(3):249-255. doi: 10.1016/j.aucc.2018.06.001. Epub 2018 Jul 11.
To describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU).
Inspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients.
Patients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set.
Using this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days' duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT.
This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.
描述一种针对重症监护病房（ICU）患者吸气肌训练（IMT）的多学科方法。
吸气肌无力是长时间机械通气的已知后果，越来越多的证据表明，特定的 IMT 可以改善这种无力。然而，IMT 在许多 ICU 中尚未成为标准实践，这可能是由于报告的方法种类繁多，以及缺乏已发表的实用指南。虽然 IMT 的最佳参数尚未确定，但我们分享了我们详细的方法，该方法已被证明在选定的呼吸机依赖患者中是安全的，并且是唯一已被证明能提高 ICU 患者生活质量的方法。
经历过至少 7 天有创机械通气的患者可以在呼吸机依赖阶段或从机械通气脱机后开始 IMT。强度应根据最大吸气压力来规定，最大吸气压力可以通过气管造口或气管内管通过呼吸机或呼吸压力计来测量。我们建议使用可移动阈值装置进行高强度训练（至少 50%最大吸气压力的 6 次呼吸，5 组），每天一次，由物理治疗师监督，每天增加强度，以使患者只能在每组的第 6 次呼吸中完成。
使用这种高强度方法，IMT 不仅可能改善吸气肌力量，而且可能改善最近机械通气 7 天或更长时间的患者的生活质量。有效的 IMT 需要多学科方法来最大限度地提高可行性，医生、护士和治疗师密切合作，为成功的 IMT 优化条件。
这种在 ICU 患者中实施 IMT 的多学科方法应有助于临床医生将最佳现有证据转化为实践，有可能增强患者的康复。
