Change In Maximal Inspiratory Pressure Research Articles

Effectiveness of Respiratory Muscle Training in Pompe Disease: A Systematic Review and Meta-Analysis.

Background: Pompe disease is a rare metabolic myopathy caused by the lack or deficiency of the lysosomal acid alpha-glucosidase, resulting in skeletal muscle weakness and cardiomyopathy. The disease varies by onset age and genetic mutations and is categorized into infantile-onset and late-onset Pompe disease. Respiratory muscle weakness may persist regardless enzyme replacement therapy. This systemic review and meta-analysis aim to assess the effect of respiratory muscle training (RMT) on respiratory muscle strength, functional endurance, and pulmonary function in patient with Pompe disease. Methods: PubMed, EMBASE, and Cochrane databases were searched up until Aug 2024. Studies examining the therapeutic effects of RMT in patients with Pompe disease were included. Outcome measures included the change in maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), six-minute walking test (6MWT), pulmonary function before after RMT, quality of life and adverse events. Results: The meta-analysis consisted of 5 single-arm studies, including 31 patients in total. Regarding inspiratory muscle strength, RMT has significantly improving MIP (8.71 cmH2O; 95% CI, 6.23-11.19, p < 0.001) and MEP (12.15 cmH2O; 95% CI, 10.55-13.74, p < 0.001) in both types of Pompe disease. However, no significant change regarding 6MWT. No serious adverse events were reported. Conclusions: Our meta-analysis revealed that RMT may increase inspiratory muscle and expiratory muscle strength, but may not have an effect on 6MWT in patients with Pompe disease. RMT has potential to be integrated into the cardioplulmonary rehabilitation for patients with Pompe disease. Further large randomized controlled trials are needed to verify the efficacy and safety of RMT in patients with Pompe disease.

Comparison of two inspiratory muscle training protocols in people with spinal cord injury: a secondary analysis

Study design/settingSecondary analysis.ObjectivesTo compare the change in maximal inspiratory pressure (PImax) over the first 4 weeks of two different inspiratory muscle training (IMT) protocols and explore if either method is more effective for people with spinal cord injury.MethodsData originated from two published studies. Participants completed flow-resistive IMT (F-IMT) at 80% daily PImax, 7 days/week (supervised weekly), or threshold IMT (T-IMT) at 30–80% weekly PImax, twice-daily, 5 days/week (supervised every session). Seven participants from each trial were matched by training adherence, level of spinal cord injury, impairment grade (A–C), and height. Differences between F-IMT and T-IMT groups in training intensity, breaths taken, inspiratory work, and the change in the PImax from baseline at the end of week four were analysed.ResultsOver 4 weeks, there was no difference in the change in PImax between groups (Absolute change in PImax (cmH2O): p = 0.456, Percent change in PImax relative to baseline: p = 0.128). F-IMT participants trained at a higher intensity (median: 77 vs 22 cmH2O, p = 0.001 and 80% baseline vs 61% baseline, p = 0.038) but took fewer breaths (840 vs 1404 breaths, p = 0.017) than T-IMT participants. Inspiratory work was similar between groups (64,789 vs 65,910 (% PImax × number of breaths), p = 0.535).ConclusionsOur findings support both methods of IMT as the change in PImax and inspiratory work were similar between groups. However, daily high-intensity F-IMT with intermittent supervision, required fewer breaths and less participant and therapist time. Future studies should examine optimal dosage and supervision required to achieve increased PImax.

A randomised controlled trial of prehabilitation in patients undergoing elective cardiac surgery.

The feasibility, safety and efficacy of prehabilitation in adult patients awaiting elective cardiac surgery are unknown. A total of 180 participants undergoing elective cardiac surgery were allocated randomly to receive either standard pre-operative care or prehabilitation, consisting of pre-operative exercise and inspiratory muscle training. The primary outcome was change in six-minute walk test distance from baseline to pre-operative assessment. Secondary outcomes included change in inspiratory muscle strength (maximal inspiratory pressure); sarcopenia (handgrip strength); quality of life and compliance. Safety outcomes were pre-specified surgical and pulmonary complications and adverse events. All outcomes were assessed at baseline; at pre-operative assessment; and 6 and 12 weeks following surgery. Mean (SD) age was 64.7 (10.2) years; 33/180 (18%) were women. In total, 65/91 (71.4%) participants who were allocated to prehabilitation attended at least four of eight supervised in-hospital exercise classes; participants aged > 50 years were more likely than younger participants to attend (odds ratio (95%CI) of 4.6 (1.0-25.1)). Six-minute walk test was not significantly different between groups (mean difference (95%CI) -7.8 m (-30.6-15.0), p = 0.503) in the intention-to-treat analysis. Subgroup analyses based on tests for interaction indicated improvements in six-minute walk test distance were larger amongst sarcopenic patients in the prehabilitation group (p = 0.004). Change in maximal inspiratory pressure from baseline to all time-points was significantly greater in the prehabilitation group, with the greatest mean difference (95%CI) observed 12 weeks after surgery (10.6 cmH2 O (4.6-16.6) cmH2 O, p < 0.001). There were no differences in handgrip strength or quality of life up to 12 weeks after surgery. There was no significant difference in postoperative mortality (one death in each group), surgical or pulmonary complications. Of 71 pre-operative adverse events, six (8.5%) were related to prehabilitation. The combination of exercise and inspiratory muscle training in a prehabilitation intervention before cardiac surgery was not superior to standard care in improving functional exercise capacity measured by six-minute walk test distance pre-operatively. Future trials should target patients living with sarcopenia and include inspiratory muscle strength training.

Temporary Transvenous Diaphragmatic Neurostimulation in Prolonged Mechanically Ventilated Patients: A Feasibility Trial (RESCUE 1).

Objectives:Prolonged mechanical ventilation promotes diaphragmatic atrophy and weaning difficulty. The study uses a novel device containing a transvenous phrenic nerve stimulating catheter (Lungpacer IntraVenous Electrode Catheter) to stimulate the diaphragm in ventilated patients. We set out to determine the feasibility of temporary transvenous diaphragmatic neurostimulation using this device.Design:Multicenter, prospective open-label single group feasibility study.Setting:ICUs of tertiary care hospitals.Patients:Adults on mechanical ventilation for greater than or equal to 7 days that had failed two weaning trials.Interventions:Stimulation catheter insertion and transvenous diaphragmatic neurostimulation therapy up to tid, along with standard of care.Measurements and Main Results:Primary outcomes were successful insertion and removal of the catheter and safe application of transvenous diaphragmatic neurostimulation. Change in maximal inspiratory pressure and rapid shallow breathing index were also evaluated. Eleven patients met all entry criteria with a mean mechanical ventilation duration of 19.7 days; nine underwent successful catheter insertion. All nine had successful mapping of one or both phrenic nerves, demonstrated diaphragmatic contractions during therapy, and underwent successful catheter removal. Seven of nine met successful weaning criteria. Mean maximal inspiratory pressure increased by 105% in those successfully weaned (mean change 19.7 ± 17.9 cm H2O; p = 0.03), while mean rapid shallow breathing index improved by 44% (mean change –63.5 ± 64.4; p = 0.04).Conclusions:The transvenous diaphragmatic neurostimulation system is a feasible and safe therapy to stimulate the phrenic nerves and induce diaphragmatic contractions. Randomized clinical trials are underway to compare it to standard-of-care therapy for mechanical ventilation weaning.

Alteration of Inspiratory Muscle Strength is Related to Change in Deep Breathing Heart Rate Variability in Patients Submitted to Open-Heart Surgery

Aim: Despite the reduction of respiratory muscle strength and cardiac autonomic modulation after open-heart surgery has been demonstrated, the association between changes in both variables has not been investigated. This study aimed to determine the correlation between change in inspiratory muscle strength and change in deep breathing heart rate variability in patients submitted to open-heart surgery.Material and Methods: An observational cross-sectional study was conducted among 32 participants aged between 35 and 60 years who were undergoing coronary artery bypass graft and cardiac valve surgery. Inspiratory muscle strength was assessed by measuring maximal inspiratory pressure using a respiratory pressure meter (RPM 01, Micro Medical Ltd., United Kingdom). Deep breathing heart rate variability was collected using a Polar heart rate monitor (Polar Electro Ltd., Finland) during a slow and deep breathing control. Evaluations were performed on the day of admission and discharge.Results: There was statistically significant reduction in maximal inspiratory pressure and deep breathing heart rate variability indices in discharge period (p&amp;lt;0.05). The difference of expiratory/inspiratory ratio and inspiratory-expiratory differences was significantly correlated with the change in maximal inspiratory pressure in both absolute (r=-0.864, p=0.003 and r=-0.841, p=0.004, respectively) and percentages of predicted values (r=-0.868, p=0.003 and r=-0.834, p=0.005, respectively).Conclusion: Inspiratory muscle weakness was related to impair cardiac vagal modulation in patients who had undergone open-heart surgery. The present study could provide rehabilitation targets to improve inspiratory muscle strength and cardiac vagal tone.

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

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).

The correlation of respiratory muscle strength and cough capacity in stroke patients.

[Purpose] The purpose of this study was to investigate the correlation between respiratory muscle strength and cough capacity in stroke patients. [Subjects and Methods] Forty-two stroke patients were assigned to 2 different groups (intervention group=21, control group=21). Both groups participated in a conventional stroke rehabilitation program, with the intervention group also receiving respiratory muscle training for 20 to 30 minutes a day, 3 times a week for 8 weeks. Respiratory muscle strength (maximal inspiratory pressure, maximal expiratory pressure), forced vital capacity, and cough capacity were measured. [Results] The intervention group showed significant increases in maximal inspiratory pressure, maximal expiratory pressure, forced vital capacity, and cough capacity. The change in maximal inspiratory pressure, maximal expiratory pressure, and forced vital capacity showed a significant correlation with cough capacity, with maximal expiratory pressure showing the highest correlation. [Conclusion] The present study showed that the increase in maximal expiratory pressure plays an important role in improving the cough capacity of stroke patients.

Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial

Does inspiratory muscle training improve maximal inspiratory pressure in intubated older people? Does it improve breathing pattern and time to wean from mechanical ventilation? Randomised trial with concealed allocation and intention-to-treat analysis. 41 elderly, intubated adults who had been mechanically ventilated for at least 48 hr in an intensive care unit. The experimental group received usual care plus inspiratory muscle training using a threshold device, with an initial load of 30% of their maximal inspiratory pressure, increased by 10% (absolute) daily. Training was administered for 5 min, twice a day, 7 days a week from the commencement of weaning until extubation. The control group received usual care only. The primary outcome was the change in maximal inspiratory pressure during the weaning period. Secondary outcomes were the weaning time (ie, from commencement of pressure support ventilation to successful extubation), and the index of Tobin (ie, respiratory rate divided by tidal volume during a 1-min spontaneous breathing trial). Maximal inspiratory pressure increased significantly more in the experimental group than in the control group (MD 7.6 cmH(2)0, 95% CI 5.8 to 9.4). The index of Tobin decreased significantly more in the experimental group than in the control group (MD 8.3 br/min/L, 95% CI 2.9 to 13.7). In those who did not die or receive a tracheostomy, time to weaning was significantly shorter in the experimental group than in the control group (MD 1.7 days, 95% CI 0.4 to 3.0). In intubated older people, inspiratory muscle training improves maximal inspiratory pressure and the index of Tobin, with a reduced weaning time in some patients. NCT00922493.

Inspiratory Muscle Fatigue in Male University Rugby Players

Rugby Union is a team based invasion game played on a grass field between two teams of 15 players. The game is played over two 40 minute periods and involves a high level of physiological strain. PURPOSE: The aim of this study was to investigate the change in Maximal Inspiratory Pressure (MIP) that occurs in University players as a result of a game of Rugby Union. METHODS: Thirty male Loughborough University rugby union players (Age 20.1 + 0.82 years, Stature 1.84 + 0.07m, Mass 92.4 + 10.1kg from the first and second team squads played a fully officiated 80 minute 'training' game against each other. Maximal Inspiratory Pressure (MIP) as measured at the mouth (Micro medical-RPM) was taken post warm up but before the game (PRE), during the half time interval (HALF) and again post game (POST). Players were described as either forwards (FOR) or backs (BACK) depending upon their playing position. All players had previously undergone a familiarisation process with the instrumentation, the testing process and the MIP measurements themselves. RESULTS: A repeated measures ANOVA (SPSSv15.0.1) showed there to be significant variability within the data set (p>0.05). Post hoc pairwise comparisons showed the difference was for all cases (PRE v HALF, PRE v POST and HALF v POST). This difference remained when the group was split for position played (FOR PRE v FOR POST and BACKS PRE v BACKS POST) however, there were no differences present when the playing positions were compared against each other (PRE FOR v PRE BACKS and POST FOR v POST BACKS. Bland and Altman 95% limits of agreement were also calculated for the player position comparison (16.1 + 68.3 mmH2O) as well as the PRE-Post comparison (-22.4 + 40.1 mmH2O). MIP scores were not significantly correlated against Body Mass (r2 0.0004) or Stature ( r2 0.0003). CONCLUSIONS: Rugby players show a reduction in MIP post-game which may be due to the physiological strain imposed by the demands of the game. There is a large degree of variability in MIP between individuals regardless of their playing position or physical dimensions. In order to ascertain whether this reduction in MIP can be attenuated this study should be repeated following a period of Inspiratory muscle training.

Pulmonary rehabilitation improves exercise tolerance in patients with bronchiectasis

For patients with bronchiectasis, does pulmonary rehabilitation either with or without inspiratory muscle training (IMT) improve exercise tolerance? Randomised controlled trial. Outpatient-based pulmonary rehabilitation program of a UK hospital. Patients with bronchiectasis confirmed by highresolution computer tomography. Exclusion criteria included concomitant emphysema, an acute exacerbation in the previous six weeks, long-term oral corticosteroid use, and significant co-morbidities. Thirty-two patients were randomised to pulmonary rehabilitation plus IMT (PRIMT) (n = 12), pulmonary rehabilitation plus sham IMT (PR-Sham) (n = 11), or a control group with no intervention (n = 9). Pulmonary rehabilitation consisted of exercise training and multidisciplinary education sessions for eight weeks. Exercise consisted of three 45- minute periods per week with a target exercise intensity of 80% of the peak heart rate achieved on an initial maximal incremental exercise test. Two sessions per week were performed at the hospital and involved cycling, treadmill walking, and stair climbing. A third session of walking was performed at home, using the Borg dyspnoea scale to guide intensity. IMT was performed for 15 minutes twice daily over the eight-week period using a pressure threshold device. Pressure was set at 30% of the patient's maximal inspiratory pressure and increased by 5% each week to a maximum of 60%. Sham IMT followed the same regimen except that the pressure was always 7 cmH 2 O. The incremental shuttle walk test, endurance exercise capacity, and respiratory muscle strength were assessed in all groups at baseline and at the end of the program. The endurance exercise test involved walking on a treadmill at 85% of peak oxygen uptake. Over the eight weeks, improvement in the incremental shuttle walk test was significantly greater in the PR-IMT group (by 113 m, 95% CI 45 to 182) and PRSham group (by 86 m, 95% CI 42 to 130) than the control group. Similarly, change in endurance exercise capacity was significantly better in the PR-IMT group (by 720 m, 95% CI 342 to 1098) and PR-Sham group (by 505 m, 95% CI 128 to 883) than the control group. Change in maximal inspiratory pressure was significantly better in the PR-IMT group (by 23 cmH 2 O, 95% CI 10 to 36) and the PR-Sham group (by 14 cmH 2 O, 95% CI 2 to 25) than that seen in the control group. The inclusion of IMT did not produce a statistically significant benefit over pulmonary rehabilitation alone for these outcomes during the training period. Pulmonary rehabilitation with or without IMT improves exercise tolerance and inspiratory muscle strength in subjects with bronchiectasis.

Objective measures of the efficacy of noninvasive positive-pressure ventilation in amyotrophic lateral sclerosis.

The impact of noninvasive positive-pressure ventilation (NIPPV) on pulmonary function studies, quality of life, and survival was assessed in patients with amyotrophic lateral sclerosis. NIPPV did not change the rate of decline of the forced vital capacity (FVC) and forced expiratory volume in the first second (FEV(1)) (2.31 and 2.09 percent-predicted points per month, respectively). NIPPV resulted in a drop of FEV(1) by 5.94 percent-predicted points (P = 0.07), and of maximal inspiratory pressure by 6.33 percent-predicted points (P = 0.11). The change in FEV(1) and FVC pre- and postintervention correlated with the corresponding change in maximal inspiratory pressure. Fatigue and mastery scores were improved by NIPPV. Median survivals in patients intolerant and tolerant of NIPPV were 5 and 20 months, respectively (P = 0.002). Although NIPPV has no impact on the rate of decline of lung function and may have deleterious effects on spirometric measures, it may improve quality of life and survival.