Chagas Gustavo Rodrigues das, Vieira Aléxia Gabriela da Silva, Araújo Jamile Caroline Garbuglio de, Eid Raquel Afonso Caserta, Mól Caroline Gomes, Nawa Ricardo Kenji
Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2025 Jul 18;23:eRW1134. doi: 10.31744/einstein_journal/2025RW1134. eCollection 2025.
OBJECTIVE: To systematically review and analyze studies investigating the efficacy and safety of inspiratory muscle training in adult chronic critically ill patients. METHODS: The MEDLINE, Embase, CENTRAL, LILACS, Clinical Trials Registry, and World Health Organization databases were queried on November 24, 2022 and January 22, 2025. The review was conducted in accordance with the PRISMA guidelines. RevMan V5.4 was used to analyze mean differences or standardized mean differences and 95% confidence intervals (95%CIs) for continuous variables and risk ratios with 95%CIs for dichotomous outcomes. The primary outcomes were inspiratory muscle strength, duration of mechanical ventilation, and severe adverse events; the secondary outcomes were hospital and intensive care unit mortality, intensive care unit and hospital lengths of stay, pulmonary function, non-serious adverse events, respiratory muscle mass, and functional status. RESULTS: Seven studies (n=390 participants) were included in the analysis. There was a significant increase in inspiratory muscle strength with inspiratory muscle training versus usual care (mean difference, -8.37; 95%CI= -15.21 to -1.52), although the certainty of evidence was very low; when compared with sham interventions, there was no significant difference (mean difference, -4.26; 95%CI= -14.05 to 5.53), also with very low certainty of evidence. The results for pulmonary function, duration of mechanical ventilation, and mortality were imprecise, with very low certainty of evidence. The available evidence also indicates the potential safety benefit of inspiratory muscle training, although the certainty of evidence remains very low. Conclusion: We identified that inspiratory muscle training may improve inspiratory muscle strength, with little to no difference on duration of mechanical ventilation, pulmonary function and severe and non-serious adverse events, when compared to sham inspiratory muscle training and usual care. However, the certainty of the evidence is very low. Evidence regarding the impact of inspiratory muscle training on intensive care unit mortality and length of stay is uncertain. Prospero database registration ID CRD42022370750.
目的：系统评价和分析关于吸气肌训练对成年慢性危重症患者疗效和安全性的研究。 方法：于2022年11月24日和2025年1月22日检索MEDLINE、Embase、CENTRAL、LILACS、临床试验注册库和世界卫生组织数据库。本综述按照PRISMA指南进行。使用RevMan V5.4分析连续变量的平均差或标准化平均差及95%置信区间（95%CI），以及二分结局的风险比及95%CI。主要结局为吸气肌力量、机械通气时间和严重不良事件；次要结局为医院和重症监护病房死亡率、重症监护病房和住院时间、肺功能、非严重不良事件、呼吸肌质量和功能状态。 结果：分析纳入7项研究（n = 390名参与者）。与常规治疗相比，吸气肌训练使吸气肌力量显著增加（平均差，-8.37；95%CI = -15.21至-1.52），尽管证据确定性非常低；与假干预相比，无显著差异（平均差，-4.26；95%CI = -14.05至5.53），证据确定性也非常低。肺功能、机械通气时间和死亡率的结果不精确，证据确定性非常低。现有证据还表明吸气肌训练可能具有潜在的安全性益处，尽管证据确定性仍然非常低。结论：我们发现，与假吸气肌训练和常规治疗相比，吸气肌训练可能会提高吸气肌力量，在机械通气时间、肺功能以及严重和非严重不良事件方面几乎没有差异。然而，证据确定性非常低。关于吸气肌训练对重症监护病房死亡率和住院时间影响的证据尚不确定。Prospero数据库注册编号CRD42022370750。
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