Inspiratory muscle weakness is a known consequence of mechanical ventilation and a potential contributor to difficulty in weaning from ventilatory support. Inspiratory muscle training (IMT) reduces the weaning period and increases the likelihood of successful weaning in some patients. However, it is not known how this training affects the residual inspiratory muscle fatigability following successful weaning nor patients' quality of life or functional outcomes.
Methods and analysis
This dual centre study includes two concurrent randomised controlled trials of IMT in adult patients who are either currently ventilator-dependent (>7 days) (n=70) or have been recently weaned from mechanical ventilation (>7 days) in the past week (n=70). Subjects will be stable, alert and able to actively participate and provide consent. There will be concealed allocation to either treatment (IMT) or usual physiotherapy (including deep breathing exercises without a resistance device). Primary outcomes are inspiratory muscle fatigue resistance and maximum inspiratory pressures. Secondary outcomes are quality of life (Short Form-36v2, EQ-5D), functional status (Acute Care Index of Function), rate of perceived exertion (Borg Scale), intensive care length of stay (days), post intensive care length of stay (days), rate of reintubation (%) and duration of ventilation (days).
Ethics and dissemination
Ethics approval has been obtained from relevant institutions, and results will be published with a view to influencing physiotherapy practice in the management of long-term ventilator-dependent patients to accelerate weaning and optimise rehabilitation outcomes.
Trial registration number
Mechanical ventilation (MV) is known to cause inspiratory muscle weakness, which may contribute to both difficulty weaning and poor recovery.
Can IMT hasten weaning and enhance recovery from MV if commenced while still ventilated?
Can IMT enhance recovery if commenced following weaning from MV?
This protocol outlines two concurrent randomised controlled trials that investigate the effects of IMT as a component of early rehabilitation in an Australian intensive care unit.
The study is designed to capture both physiological measures as well as patient-centred measures of function and quality of life.
Strengths and limitations of this study
This study is the first of its kind to focus on patient-centred measures and longer term outcomes beyond the period of ventilatory weaning.
The results of this study will not be generalisable to some intensive care units, which generally keep patients sedated, as patient alertness is a requirement of IMT.