Department of Physical Therapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, the Netherlands.
Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, the Netherlands; Amsterdam University Medical Centers, Location AMC, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, Netherlands.
Aust Crit Care. 2024 Nov;37(6):851-858. doi: 10.1016/j.aucc.2024.01.005. Epub 2024 Feb 6.
Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive care units (ICUs).
The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients.
This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed.
Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: "professional barriers", "external factors", and "patient barriers".
Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice.
机械通气患者有发生吸气肌无力（IMW）的风险，这与脱机失败和不良预后有关。吸气肌训练（IMT）是拔管期间和之后的推荐干预措施，但在荷兰重症监护病房（ICU）并未广泛采用。
本研究旨在探讨在荷兰 ICU 中实施 IMT 作为机械通气患者治疗方式的潜力、障碍和促进因素。
这是一项混合方法、概念验证研究，在荷兰的一家大型学术医院进行。在 2021 年的 8 个月期间，对 ICU 中通气时间≥24 小时的患者应用了一种基于证据的评估 IMW 和训练的方案。回顾性收集 ICU 期间和之后完成的测量和干预的定量数据，并进行描述性分析。通过对执行新方案的物理治疗师进行半结构化访谈收集定性数据。访谈数据被转录并进行主题分析。
在筛选的 301 名患者中，11.6%（n=35）符合纳入标准。94.3%的参与者可进行测量，78.8%的参与者存在 IMW。96%的患者在 ICU 开始训练，88.5%的患者在转至病房后继续训练。73.1%的呼吸肌无力患者进行了随访测量。对 12 名治疗师进行了访谈，其中 41.7%定期在 ICU 工作。在探讨方案偏离的原因时，出现了三个主题：“专业障碍”、“外部因素”和“患者障碍”。
在这项单中心研究中，实施 IMW 的测量和干预措施具有挑战性。临床医生改变其处理方式的意愿与对有用性、有效性以及时间和材料可用性的信念有关。我们建议，旨在在呼吸机脱机期间或之后实施 IMT 的医院，应考虑这些专业和组织障碍，以便将新的、基于证据的干预措施实施到日常临床实践中。
