Inspiratory Muscle Strength In Patients Research Articles

Enhanced diaphragm excursion and exercise tolerance in COPD patients through inspiratory muscle training after standardised pulmonary rehabilitation: randomised controlled trial

ObjectiveInspiratory muscle training (IMT) is used to improve inspiratory muscle strength in patients with chronic obstructive pulmonary disease (COPD). However, the effect of IMT on diaphragmatic function has not yet been thoroughly evaluated. This study aimed to evaluate the effect of IMT on maximum diaphragmatic excursion (DEmax) using ultrasonography in patients with COPD.MethodsThis was a single-center, randomised, prospective, parallel-group, unblinded controlled trial involving 38 participants with stable COPD. Participants underwent a standardised 12-week pulmonary rehabilitation (PR) program followed by a 12-week IMT program, consisting of home-based IMT and low-frequency outpatient PR sessions supervised by physiotherapists (once every 2 weeks),versuslow-frequency outpatient PR alone as a control. The DEmaxand exercise tolerance were measured.ResultsOut of the 38 patients initially enrolled in the PR program, 33 successfully completed it and were subsequently randomised to the IMT program. Finally, 15 (94%) and 14 (88%) patients from the IMT and control groups, respectively, completed the study. Following the IMT program, DEmaxincreased in the IMT group (50.1±7.6 mm to 60.6±8.0 mm, p<0.001), but not in the control group (47.4±7.9 mm to 46.9±8.3 mm, p=0.10). Changes in DEmaxand exercise tolerance (peak VO2) were greater in the IMT group than in the control group (both p<0.01).ConclusionsIMT following the PR program improved DEmaxand exercise tolerance. Therefore, DEmaxmay be an important outcome of IMT.

Neural respiratory drive assessment and its correlation with inspiratory muscle strength in patients undergoing open-heart surgery: A cross-sectional study.

Pulmonary dysfunction and inspiratory muscle weakness are frequently observed after cardiac surgery. Understanding the load on and capacity of respiratory muscles can provide valuable insights into the overall respiratory mechanics and neural regulation of breathing. This study aimed to assess the extent of neural respiratory drive (NRD) and determine whether admission-to-discharge differences in NRD were associated with inspiratory muscle strength changes among patients undergoing open-heart surgery. This cross-sectional study was conducted on 45 patients scheduled for coronary artery bypass graft or heart valve surgery. NRD was measured using a surface parasternal intercostal electromyogram during resting breathing (sEMGpara tidal) and maximal inspiratory effort (sEMGpara max). Maximal inspiratory pressure (MIP) was used to determine inspiratory muscle strength. Evaluations were performed on the day of admission and discharge. There was a significant increase in sEMGpara tidal (6.9±3.6μV, p<0.001), sEMGpara %max (13.7±11.2%, p=0.008), and neural respiratory drive index (NRDI, the product of EMGpara %max and respiratory rate) (337.7±286.8%.breaths/min, p<0.001), while sEMGpara max (-43.6±20.4μV, p<0.01) and MIP (-24.4±10.7, p<0.001) significantly decreased during the discharge period. Differences in sEMGpara tidal (r=-0.369, p=0.045), sEMGpara %max (r=-0.646, p=0.001), and NRDI (r=-0.639, p=0.001) were significantly associated with a reduction in MIP. The findings indicate that NRD increases after open-heart surgery, which corresponds to a decrease in inspiratory muscle strength.

The impact of anti-eosinophilic therapy on exercise capacity and inspiratory muscle strength in patients with severe asthma.

Exercise limitation is frequently described among asthmatic patients and could be related to different mechanisms of the pulmonary, cardiovascular and muscular systems. Despite this, cardiopulmonary exercise testing (CPET) does not have an established role in the management of severe asthma. The aim of our study was to investigate the role of CPET and inspiratory pressure measurement in exercise capacity and muscle strength in severe asthmatic patients treated with anti-IL-5 therapy. A monocentric observational study was conducted at Hanover Medical School, Germany, from April 2018 to June 2019. Patients affected by severe asthma treated with either mepolizumab or benralizumab were included. All patients underwent CPET before the initiation of antibody therapy and after 3 months, and follow-up visits were scheduled at 3, 6 and 12 months with plethysmography, inspiratory pressure measurement and blood gas analysis. 14 patients were enrolled: 10 (71.4%) females, median age 52 years (IQR 47-61). Seven patients were treated with benralizumab, seven with mepolizumab. Oxygen uptake (V'O2 peak) did not change significantly after 3 months of antibody treatment, while the mean value of the breathing reserve exhaustion reduced significantly from 78% to 60% (p=0.004). Whereas at baseline seven patients depleted the breathing reserve and two of them experienced oxygen desaturation during exercise, at 3 months no one presented any desaturation or breathing reserve exhaustion. The inspiratory pressure remained unchanged before and after the antibody therapy. CPET could show hints of alveolar recruitment and ventilatory efficiency in severe asthma patients treated with antibody therapy.

Efficacy of Power Breathe Device versus Threshold Inspiratory Muscle Training Device on Inspiratory Muscle Strength in Upper Abdominal Surgery Patients: A Research Protocol

Introduction: Surgery care is important in the treatment of a variety of disorders as well as the alleviation of human suffering. Surgery is essential for meeting basic healthcare needs all across the world, although to varying degrees depending on disease subtypes and epidemiological regions. Laparoscopic surgery is now widely established. Benefits of laparoscopic surgery include improved cosmetic results, reduced postoperative pain, and reduced length of hospital stay with patient satisfaction. Upper abdominal surgery initiates a series of physiological events that result in postoperative pulmonary complications such as increased morbidity, mortality, and hospitalisation. Preoperatively in abdominal surgeries, Inspiratory Muscle Training (IMT) devices have been used to reduce postoperative pulmonary complications as well as improve the quality of life of the patients. Need of the study: Surgery is a crucial part of the healthcare system, and it has a direct impact on the respiratory system. With changes in postoperative pulmonary functions, there are limitations in lung volume and capacities such as total lung capacity, vital capacity, and tidal volume. Power breathe devices have been utilised preoperatively in abdominal procedures for inspiratory muscle training and to prevent postpulmonary complications. As a result, the purpose of this study is to see how the power breath device and the threshold IMT device affect inspiratory muscle strength in upper abdominal operations. Aim: To compare the effect of a power breathe device versus a threshold inspiratory muscle training device on inspiratory muscle strength in patients who had upper abdominal surgery. Methodology: The present comparative research protocol is planned to be conducted on 60 patients with upper abdominal surgery with reduced inspiratory muscle strength. The expected study duration is of one year from 2022 to 2023.Total subjects will be randomly divided into two groups, Group-A will receive power breathe plus conventional physiotherapy five days per week and Group-B will receive threshold IMT plus conventional physiotherapy five days per week for period of two weeks. Before initiating the intervention, patients will have their PImax (maximal inspiratory pressure) evaluated using hand-held pressure manometer equipment. After two weeks, patients will be reviewed again using the same outcome measures. Expected Results/Outcomes: Threshold IMT device along with conventional physiotherapy incorporated preoperatively for the patients is expected to give better results postoperatively

The Impact of Anti-Eosinophilic Therapy on Exercise Capacity and Inspiratory Muscle Strength in Patients with Severe Asthma

The Impact of Anti-Eosinophilic Therapy on Exercise Capacity and Inspiratory Muscle Strength in Patients with Severe Asthma

Functionally relevant threshold of inspiratory muscle strength in patients with chronic obstructive pulmonary disease

ObjectivesWe aimed to identify the inspiratory muscle strength thresholds below which exercise capacity is compromised in men with chronic obstructive pulmonary disease (COPD). MethodsWe measured the maximum static inspiratory mouth pressure (PImax) and the percentage of predicted values (%PImax) in 113 patients with COPD. Six-minute walk distance (6-MWD) was measured as an indicator of functional exercise capacity, and a 6-MWD of <350 m was defined as functional exercise intolerance. Thresholds were determined as values with high specificity (>0.90) and maximal sensitivity. Statistical significance was set at P < 0.01. ResultsThe data of 96 patients (74 ± 6 years old; forced expiratory volume in 1-s [FEV1], 56.5 ± 26.2% predicted) were analyzed; three women and 14 participants with missing data were excluded. Multivariate logistic regression models identified significant associations of PImax (odds ratio at 99% confidence interval [CI]: 0.95 [0.92–0.98]) and %PImax (odds ratio at 99% CI: 0.97 [0.95–0.99]) with 6-MWD, after adjustments for height and FEV1. C-statistics showed that the area under the curves (99% CI) of PImax and %PImax were comparable (0.87 [0.77–0.96] and 0.83 [0.72–0.94]). The thresholds of PImax and %PImax were 45.1 cmH2O and 66%; PImax and %PImax also had moderate positive likelihood ratios of 4.44 and 5.00. ConclusionsThresholds of inspiratory muscle strength in men with COPD could help clinicians evaluate whether their patient's inspiratory muscle strength is inadequate to achieve a 6-MWD of ≥350 m, and identify patients who should be targeted for inspiratory muscle training.

Reduced inspiratory muscle strength increases pneumonia in patients with acute myocardial infarction.

Inspiratory muscle strength is associated with pneumonia in patients after surgery or those with subacute stroke. However, inspiratory muscle strength in patients with acute myocardial infarction (AMI) has not been studied. To evaluate the predictive value of inspiratory muscle strength for pneumonia in patients with AMI. Patients with AMI were consecutively enrolled from March 2019 to September 2019. Measurements of maximal inspiratory pressure (MIP) were used to estimate inspiratory muscle strength and mostly were taken within 24 hr after culprit-vessel revascularization. Patients were divided into 3 groups by MIP tertile (T1: <56.1cm H2O, n=88; T2: 56.1-84.9cm H2O, n=88; T3: >84.9cm H2O, n=89). The primary endpoint was in-hospital pneumonia. Among 265 enrolled patients, pneumonia developed in 26 (10%). The rates of pneumonia were decreased from MIP T1 to T3 (T1: 17%, T2: 10%, T3: 2%, P=0.004). In-hospital all-cause mortality and major adverse cardiovascular events (MACEs) did not differ between groups. Multivariate logistic regression confirmed increased MIP associated with reduced risk of pneumonia (odds ratio 0.78, 95% confidence interval 0.65-0.94, P=0.008). Receiver operating characteristic curve analysis indicated that MIP had good performance for predicting in-hospital pneumonia, with an area under the curve of 0.72 (95% confidence interval 0.64-0.81, P<0.001). The risk of pneumonia but not in-hospital mortality and MACEs was increased in AMI patients with inspiratory muscle weakness. Future study focused on training inspiratory muscle may be helpful.

Maximal Dynamic Inspiratory Pressure Evaluation in Heart Failure: A Comprehensive Reliability and Agreement Study

The purpose of this study was to analyze the reliability (interrater and intrarater) and agreement (repeatability and reproducibility) properties of tapered flow resistive loading (TFRL) measures in patients with heart failure (HF). For this cross-sectional study, participants were recruited from the cardiopulmonary rehabilitation program at the University of Brasilia from July 2015 to July 2016. All patients participated in the study, and 10 were randomly chosen for intrarater and interrater reliability testing. The 124 participants with HF (75% men) were 57.6 (SD=1.81) years old and had a mean left ventricular ejection fraction of 38.9% (SD=15%) and a peak oxygen consumption of 13.05 (SD=5.3) mL·kg·min-1. The main outcome measures were the maximal inspiratory pressure (MIP) measured with a standard manovacuometer (SM) and the MIP and maximal dynamic inspiratory pressure (S-Index) obtained with TFRL. The S-Index reliability (interrater and intrarater) was examined by 2 evaluators, the S-Index repeatability was examined with 10 repetitions, and the reproducibility of the MIP and S-Index was measured with SM and TFRL, respectively. The reliability analysis revealed high S-Index interrater and intrarater reliability values (intraclass correlation coefficients [ICCs] of 0.89 [95% CI=0.58-0.98] and 0.97 [95% CI=0.89-0.99], respectively). Repeatability analyses revealed that 8 maneuvers were required to reach the maximum S-Index in 75.81% (95% CI=68.27-83.34) of the population. The reproducibility of TFRL measures (S-Index=68.8 [SD=32.8] cm H2O; MIP=66 [SD=32.3] cm H2O) was slightly lower than that of the SM measurement (MIP=70.1 [SD=35.9] cm H2O). The TFRL device provided a reliable intrarater and interrater S-Index measure in patients with HF and had acceptable repeatability, requiring 8 maneuvers to produce a stable S-Index measure. The reproducibilities of the S-Index, MIP obtained with SM, and MIP obtained with TRFL were similar. TRFL is a feasible method to assess both MIP and the S-index as measures of inspiratory muscle strength in patients with HF and can be used for inspiratory muscle training, making the combined testing and training capabilities important in both clinical research and the management of patients with HF.

Os efeitos do treinamento muscular inspiratório em pacientes sob ventilação mecânica invasiva no processo de desmame: revisão de literatura

Introdução: O tempo prolongado de ventilação mecânica associado a um período extenso de desmame também pode estar relacionado com a fraqueza muscular respiratória. O treinamento muscular inspiratório (TMI) é um recurso terapêutico usado para promover o aumento da força e da resistência dos músculos inspiratórios, podendo contribuir para o sucesso no desmame em um tempo menor, sendo o TMI mais utilizado como dispositivo é o Threshold IMT, podendo ser mensurada a força muscular, através do manovacuômetro. Objetivos: Avaliar a eficácia da força muscular inspiratória em pacientes em treinamento muscular inspiratório submetidos ao desmame da ventilação mecânica invasiva. Método: Trata-se de uma revisão bibliográfica, com a utilização das bases de dados eletrônicas: LILACS, SciELO, MEDLINE E BIREME, referente a um período de 06 anos (2010-2016). Resultados: Foi possível observar que o treinamento muscular respiratório melhora a PImax, aumento da FC, melhora da oxigenação e força muscular inspiratória, diminui tempo de internação, melhora de PaO2, auxiliando no sucesso no desmame. Conclusão: Foi observado que a aplicação do treinamento muscular respiratório auxilia no desmame da ventilação mecânica.

Effects of a Rehabilitation Programme with a Nasal Inspiratory Restriction Device on Exercise Capacity and Quality of Life in COPD.

Objective: The objective was to assess the effects of a nasal restriction device for inspiratory muscle training, called Feelbreathe®, added to a rehabilitation program (RP) on exercise capacity, quality of life, dyspnea and inspiratory muscle strength in patients with stable COPD. Methods: Patients were randomized into three groups, one performed a supervised RP using the Feelbreathe® device (FB group), the second group developed the same RP with oronasal breathing without FB (ONB group) and the third was the control group (CG). We evaluated inspiratory muscle strength (PImax), dyspnea (mMRC), quality of life (CAT) and exercise capacity (6MWT) before and after 8-week of RP. Results: A total of 16 patients completed the study, seven in FB group, five in ONB group and four in the CG. After the RP, the FB group showed a significant increase in PImax (93.3 ± 19.1 vs. 123.0 ± 15.8 mmHg) and in the 6MWT distance (462.9 ± 71.8 m vs. 529.1 ± 50.1 m) and a decrease in the CAT score (9.7 ± 6.5 vs. 5.9 ± 6.0) and in the mMRC dyspnea score. FB provides greater improvement in PImax, dyspnea, quality of life and 6MWT than ONB. Conclusions: The Feelbreathe® device provides greater improvements in quality of life, dyspnea, exercise capacity and inspiratory muscle strength compared to patients that did not use it.

Evaluation of Inspiratory Muscle Strength in Patients With Multiple System Atrophy

Evaluation of Inspiratory Muscle Strength in Patients With Multiple System Atrophy

Factors Associated with Inspiratory Muscle Strength in Patients with Heart Failure

Factors Associated with Inspiratory Muscle Strength in Patients with Heart Failure

Short period of high-intensity inspiratory muscle training improves inspiratory muscle strength in patients with chronic kidney disease on hemodialysis: a randomized controlled trial

BackgroundChronic kidney disease is a complex disease that impacts multiple organs and systems (including musculoskeletal and cardiorespiratory) leading to reduction of functional capacity. ObjectiveThe aim of this study was to investigate the effect of a short period of high intensity inspiratory muscle training on maximum inspiratory pressure, functional capacity and endothelial function of chronic kidney disease patients on hemodialysis. MethodsThis randomized controlled trial enrolled 25 patients who were allocated into two groups: intervention (IMTG=14) and control (CG=11) groups. Intervention patients received the exercise protocol over a period of 5 weeks, 6 times per week, with each session consisting of 5 sets of 10 repetitions with an initial load of 50% progressing to 70% of maximum inspiratory pressure , measured weekly. The primary outcome was inspiratory muscle strength and the secondary outcomes were functional capacity and endothelial function evaluated before and after the training protocol. ResultsThe inspiratory muscle training induced a marked improvement in maximum inspiratory pressure which was evident after the training period (mean difference 19.0cmH2O – 95%CI 0.4–37.5; IMTG: 102±25.7cmH2O vs CG: 83±19.2; p=0.046). The magnitude of maximum inspiratory pressure improvement was 33.5% at the end of the protocol for the IMTG. Functional capacity and endothelial function did not vary between or within groups. ConclusionA short period of high-intensity inspiratory muscle training for five weeks was able to improve inspiratory muscle strength of chronic kidney disease patients on hemodialysis (ClinicalTrials.gov registration NCT03082404).

Assessment of Inspiratory Muscle Strength in Patients with Parkinson’s Disease

Assessment of Inspiratory Muscle Strength in Patients with Parkinson’s Disease

Maximum inspiratory pressure of the patients after open-heart surgery following physiotherapy

Background: After open-heart surgery, various complications require specific care, especially in the respiratory system. To reestablish it, several strategies should be used, such as respiratory muscle training, which aims to improve respiratory muscle strength, leading to a reduction in post-operative pulmonary complications in patients undergoing cardiac surgery. Aims and Objectives: The objective of the study was to measure and compare maximum inspiratory pressure (MIP) in open-heart surgery patients following conventional physiotherapy group and conventional physiotherapy plus inspiratory muscle training (IMT) group. Materials and Methods: The study was an experimental design and it was a prospective randomized control study where participants were taken from cardiac hospital using balance block computer-generated randomization method. Fifty participants were divided into two groups of 25 each. Group A received conventional physiotherapy and Group B received conventional plus inspiratory muscle exercise (B) by pressure threshold IMT instrument. Physiotherapy treatment was delivered by qualified physiotherapy, twice a day preoperatively and after extubation, 4–5 sessions per day were given until they discharged. The pre-operative, at discharge, and at the 1st follow-up, patient MIP was measured. Results: There was no statistically significant change in inspiratory muscle strength in patients exposed to an IMT program compared to the control group (P > 0.05). Conclusion: There was no difference in MIP in conventional physiotherapy and conventional plus inspiratory muscle trainer group in “pre-operative,” “discharged,” and “1st follow-up” in open-heart surgery patient.

CON: Persistent Central Sleep Apnea/Hunter-Cheyne-Stokes Breathing, Despite Best Guideline-Based Therapy of Heart Failure With Reduced Ejection Fraction, Is Not a Compensatory Mechanism and Should Be Suppressed.

CON: Persistent Central Sleep Apnea/Hunter-Cheyne-Stokes Breathing, Despite Best Guideline-Based Therapy of Heart Failure With Reduced Ejection Fraction, Is Not a Compensatory Mechanism and Should Be Suppressed.

Reduced Inspiratory Muscle Strength in Patients with Type 2 Diabetes Mellitus and Obstructive Sleep Apnoea.

Background Obstructive sleep apnoea (OSA) is related to type 2 diabetes (T2DM), and it may be associated with reduced inspiratory muscle strength (IMS). The aim of this study was to investigate the IMS in patients with T2DM, with or without OSA. Methods Patients with T2DM with OSA (n = 33) and without OSA (n = 28) were included. The maximum IMS was tested using the POWERbreathe KH2 device. Reference IMS values were data calculated using an algorithm based on general populations and adjusted for age and gender. Results There was no difference in IMS between the OSA group (median (range) 77 (35–124) cmH2O) and the non-OSA group (84 (33–122) cmH2O) (p = 0.97). The IMS values were reduced in the OSA group compared with the reference values (92.9 (62.3–100.0) cmH2O) (p = 0.030), whereas the non-OSA group did not have reduced IMS. When the IMS values of all T2DM patients were compared with reference values, the IMS values were 79 (33–124) cmH2O and 93.8 (62.3–102.4) cmH2O, respectively (p = 0.017). Conclusion No difference in IMS between patients with T2DM with or without OSA was found. However, patients with T2DM and OSA had reduced IMS compared with age- and gender-matched references whereas the non-OSA group did not have reduced IMS.

Efficacy of Inspiratory Muscle Trainer And Incentive Spirometer on Inspiratory Muscle Strength in Patients With Tetraplegia In Indian Setting

To compare effectiveness of inspiratory muscle trainer and incentive spirometer on inspiratory muscle strength in patients with quadriplegia.

Inspiratory work capacity is more severely depressed than inspiratory muscle strength in patients with heart failure: Novel applications for inspiratory muscle training

BackgroundWe hypothesized that the ability to sustain maximal inspiratory pressure (SPImax) over time as a measure of work capacity may be more severely affected than inspiratory muscle strength (PImax) in patients with heart failure (HF). MethodsWe retrospectively investigated eighty patients with HF, NYHA II/III/ ambulatoryIV and a (mean±SD) LVEF 27±8%, and compared them to 25 healthy subjects (HS). During a maximal inspiratory manoeuvre from residual volume (RV) to total lung capacity, PImax was measured as the maximum mouth pressure at RV, inspiratory contraction time (ICT) as the time from RV to end of inspiration and SPImax as the area under a pressure-time curve using an electronic pressure manometer with designed-purpose software (Trainair®, Project Electronics Ltd., London, UK). Exercise capacity was assessed with cardiopulmonary exercise testing and the 6-minute walk test (6MWT). ResultsPatients achieved a (mean±SD) peak VO2=15.7±3.4ml/kg/min and 6MWT=338±88m. PImax, ICT and SPImax were reduced in HF pts at 75%***, 61%*** and 52%*** of HS, and correlated with NYHA (r=−0.485***), (r=−0.507**), (r=−0.500***), peakVO2 (r=0.501***), (r=0.655***), (r=0.508***) and 6MWT (r=0.477***), (r=0.345**), (r=0.530***), respectively (*p<0.05, **p<0.01, ***p<0.001). ConclusionPImax, ICT and SPImax were impaired in HF patients compared to HS and may be important determinants of exercise capacity. SPImax was severely depressed even in patients with relatively preserved PImax and should be considered as an additional target index for inspiratory muscle training. Equations are provided to predict SPImax in relation to age and exercise capacity in HF.

Timed Inspiratory Effort Index, a New Diagnostic Method to Assess Endurance and Inspiratory Muscle Strength in Patients under Mechanical Ventilation

Introduction: Mechanical ventilation is a critical component of modern intensive care medicine, but the process of discontinuing mechanical ventilation could be difficult in some cases. Several studies demonstrated that the combination of diaphragmatic inactivity and mechanical ventilation periods over than 18 hours is associated with atrophy of human diaphragm myofibers. Thus, the disuse atrophy of human diaphragm myofibers could be a major contributor for weaning failures. Indeed, its proper assessment of the respiratory muscle impairment depends on the use of appropriate tests. The predicting weaning indexes are still the most commonly used tests in clinical practice at ICUs around the world, because they are more widely known and easy to use in different diseases. Objective: The aim of the present article is to describe advantages, procedures, and clinical applicability of a new method called timed inspiratory effort index, or TIE index, to assess inspiratory muscle strength and specifically address the diagnosis of muscle fatigue in patients under mechanical ventilation. Methods: This short review about a new method to assess endurance and inspiratory muscle strength of patients with respiratory weakness and undergoing weaning from mechanical ventilation. Main recommendations: The analysis of respiratory muscle function through the TIE method translates a new feature to the intensive care fast, easy, accurate, reproducible and secure. In addition, to aid in the differential diagnosis of respiratory muscle fatigue directly predict weaning, may lead the most appropriate respiratory muscle training in prolonged weaning patients. Conclusion: In summary, nowadays, the TIE index can be considered one of the most appropriate methods to evaluate the various interactions in a critical patient under mechanical ventilation. Therefore, TIE index performance as a weaning predictor is among the best rates ever reported in literature.