Wang Shu-Jane, Fang Tien-Pei, Rowley Daniel D, Liu Nan-Wei, Chen Jui-O, Liu Jui-Fang, Lin Hui-Ling
Department of Respiratory Therapy, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan.
Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
Front Med (Lausanne). 2025 Jan 29;11:1503678. doi: 10.3389/fmed.2024.1503678. eCollection 2024.
Patients undergoing mechanical ventilation often develop rapid diaphragmatic atrophy, respiratory muscle weakness, and dysfunction, which are associated with prolonged duration of ventilation. This study aimed to evaluate whether Inspiratory Muscle Training (IMT) facilitates weaning from mechanical ventilation and enhances muscle strength in critically ill, subacute adult patients, while examining the relationship between IMT and relevant clinical laboratory values.
In this randomized clinical trial, patients admitted to the intensive care unit requiring mechanical ventilation for more than 2 days, with stable hemodynamics and resolved acute conditions, were enrolled. Participants were randomly assigned to the IMT or no-IMT group. The IMT group received training twice daily, 5 days a week, for three consecutive weeks. The primary outcome was ventilator duration. The primary outcome measure was the number of days until liberation from mechanical ventilation. The secondary outcomes of interest were respiratory muscle strength and biomarker levels.
Thirty-three subjects (17 in the IMT group, 16 in the no-IMT group) were included in the final analysis. The IMT group had significantly shorter ventilator days (12.6 ± 5.2 vs. 18.1 ± 8.8, = 0.04). IMT intervention significantly reduced rapid shallow breathing index and improved respiratory muscle strength, with greater maximum inspiratory pressure ( < 0.01), maximum expiratory pressure ( = 0.03), and peak expiratory flow ( = 0.01). A moderate positive correlation was observed between IMT and increased creatinine levels (rs = 0.54, = 0.01), whereas the no-IMT group showed a reduction.
IMT significantly shortened ventilator duration and improved respiratory muscle strength. A moderate correlation between increased creatinine levels and respiratory muscle strength was observed, suggesting that creatinine may be a potential biomarker for muscle recovery during IMT.
This study was registered at ClinicalTrials.gov (NCT06611683).
接受机械通气的患者常出现膈肌快速萎缩、呼吸肌无力及功能障碍，这与通气时间延长有关。本研究旨在评估吸气肌训练（IMT）是否有助于危重症亚急性成年患者撤机并增强肌肉力量，同时探究IMT与相关临床实验室指标之间的关系。
在这项随机临床试验中，纳入了入住重症监护病房、需要机械通气超过2天、血流动力学稳定且急性病情已缓解的患者。参与者被随机分配至IMT组或非IMT组。IMT组每天接受两次训练，每周5天，连续进行三周。主要结局是通气时间。主要结局指标是脱离机械通气的天数。感兴趣的次要结局是呼吸肌力量和生物标志物水平。
最终分析纳入了33名受试者（IMT组17名，非IMT组16名）。IMT组的通气天数显著缩短（12.6±5.2天 vs. 18.1±8.8天，P = 0.04）。IMT干预显著降低了快速浅呼吸指数并改善了呼吸肌力量，最大吸气压力（P < 0.01）、最大呼气压力（P = 0.03）和呼气峰值流速（P = 0.01）均有更大改善。观察到IMT与肌酐水平升高之间存在中度正相关（rs = 0.54，P = 0.01），而非IMT组则出现下降。
IMT显著缩短了通气时间并改善了呼吸肌力量。观察到肌酐水平升高与呼吸肌力量之间存在中度相关性，提示肌酐可能是IMT期间肌肉恢复的潜在生物标志物。
本研究已在ClinicalTrials.gov注册（NCT06611683）。
