Efficacy of respiratory muscle training in weaning of mechanical ventilation in patients with mechanical ventilation for 48 hours or more: A Randomized Controlled Clinical Trial

Abstract

ObjectiveTo evaluate the efficacy of respiratory muscular training in the weaning of mechanical ventilation and respiratory muscle strength in patients on mechanical ventilation of 48h or more. DesignRandomized controlled trial of parallel groups, double-blind. Ambit: Intensive Care Unit of a IV level clinic in the city of Cali. Patients126 patients in mechanical ventilation for 48h or more. InterventionsThe experimental group received daily a respiratory muscle training program with threshold, adjusted to 50% of maximal inspiratory pressure, additional to standard care, conventional received standard care of respiratory physiotherapy. Main interest variablesWeaning of mechanical ventilation. Other variables evaluated: respiratory muscle strength, requirement of non-invasive mechanical ventilation and frequency of reintubation. AnalysisIntention-to-treat analysis was performed with all variables evaluated and analysis stratified by sepsis condition. ResultsThere were no statistically significant differences in the median weaning time of the MV between the groups or in the probability of extubation between groups (HR: 0.82; 95%CI: 0.55–1.20; p=0.29). The maximum inspiratory pressure was increased in the experimental group on average 9.43 (17.48)cm H2O and in the conventional 5.92 (11.90)cm H2O (p=0.48). The difference between the means of change in maximal inspiratory pressure was 0.46 (p=0.83; 95%CI −3.85 to −4.78). ConclusionsRespiratory muscle training did not demonstrate efficacy in the reduction of the weaning period of mechanical ventilation nor in the increase of respiratory muscle strength in the study population. Registered study at ClinicalTrials.gov (NCT02469064).