Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece.
1st Critical Care Department, General Hospital of Athens "Evagelismos", National and Kapodistrian University of Athens, 11527 Athens, Greece.
Medicina (Kaunas). 2024 May 26;60(6):869. doi: 10.3390/medicina60060869.
: Mechanical ventilation is often used in intensive care units to assist patients' breathing. This often leads to respiratory muscle weakness and diaphragmatic dysfunction, causing weaning difficulties. Inspiratory muscle training (IMT) has been found to be beneficial in increasing inspiratory muscle strength and facilitating weaning. Over the years, different protocols and devices have been used. : The aim of this systematic review and meta-analysis was to investigate the effectiveness of low-medium (LM-IMT) and high-intensity (H-IMT) threshold inspiratory muscle training in critically ill patients. A systematic literature search was performed for randomized controlled trials (RCTs) in the electronic databases Google Scholar, PubMed, Scopus, and Science Direct. The search involved screening for studies examining the effectiveness of two different intensities of threshold IMT in critically ill patients published the last 10 years. The Physiotherapy Evidence Database (PEDro) scale was chosen as the tool to assess the quality of studies. A meta-analysis was performed where possible. : Fourteen studies were included in the systematic review, with five of them having high methodological quality. : When examining LM-IMT and H-IMT though, neither was able to reach statistically significant improvement in their maximal inspiratory pressure (MIP), while LM-IMT reached it in terms of weaning duration. Additionally, no statistical difference was noticed in the duration of mechanical ventilation. The application of IMT is recommended to ICU patients in order to prevent diaphragmatic dysfunction and facilitate weaning from mechanical ventilation. Therefore, further research as well as additional RCTs regarding different protocols are needed to enhance its effectiveness.
机械通气常用于重症监护病房以辅助患者呼吸。这往往会导致呼吸肌无力和膈肌功能障碍，从而导致撤机困难。吸气肌训练（IMT）已被发现有助于增加吸气肌力量并促进撤机。多年来，已经使用了不同的方案和设备。
本系统评价和荟萃分析的目的是研究中低强度（LM-IMT）和高强度（H-IMT）阈值吸气肌训练在重症患者中的有效性。在电子数据库 Google Scholar、PubMed、Scopus 和 Science Direct 中进行了系统的文献检索，以查找过去 10 年中研究两种不同强度阈值 IMT 对重症患者有效性的随机对照试验（RCT）。选择 Physiotherapy Evidence Database（PEDro）量表作为评估研究质量的工具。在可能的情况下进行了荟萃分析。
该系统评价共纳入了 14 项研究，其中 5 项研究具有较高的方法学质量。
然而，在检查 LM-IMT 和 H-IMT 时，两者都无法在最大吸气压力（MIP）方面达到统计学上的显著改善，而 LM-IMT 在撤机持续时间方面达到了这一效果。此外，机械通气持续时间也没有观察到统计学差异。建议在 ICU 患者中应用 IMT，以预防膈肌功能障碍并促进机械通气撤机。因此，需要进一步研究和额外的 RCT 来研究不同方案，以提高其效果。
