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Meta-Analysis
. 2024 May 26;60(6):869.
doi: 10.3390/medicina60060869.

Low-Medium and High-Intensity Inspiratory Muscle Training in Critically Ill Patients: A Systematic Review and Meta-Analysis

Irini Patsaki  1 , Alexandros Kouvarakos  1   2 , Ioannis Vasileiadis  2 , Georgios A Koumantakis  1 , Eleni Ischaki  2 , Eirini Grammatopoulou  1 , Anastasia Kotanidou  2 , Eleni E Magira  2
Affiliations
Meta-Analysis

Low-Medium and High-Intensity Inspiratory Muscle Training in Critically Ill Patients: A Systematic Review and Meta-Analysis

Irini Patsaki et al. Medicina (Kaunas). .

Abstract

Background and objectives: 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. Materials and Methods: 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. Results: Fourteen studies were included in the systematic review, with five of them having high methodological quality. Conclusions: 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.

Keywords: ICU; critically ill; inspiratory muscle training; maximum inspiratory pressure; mechanical ventilation; weaning.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 3
Figure 3
Effect of low-medium -IMT on maximal inspiratory pressure (in cm H20).
Figure 4
Figure 4
Effect of high IMT on maximal inspiratory pressure (in cm H20).
Figure 5
Figure 5
Effect of low-medium IMT on weaning duration (in days).
Figure 6
Figure 6
Effect of high IMT on weaning duration (days).
Figure 7
Figure 7
Effect of low-medium-IMT on mechanical ventilation duration (in days).
Figure 8
Figure 8
Effect of high IMT on mechanical ventilation duration (in days).
Figure 9
Figure 9
Effect of IMT on Rapid Swallow Breathing Index (RSBI) (in br/min/L).
Figure 1
Figure 1
Prisma flow diagram.
Figure 2
Figure 2
Resulting risk of bias per methodological quality item assessed with the PEDro scale.
See this image and copyright information in PMC

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