Inspiratory muscle training for chronic critically ill patients: a systematic review and meta-analysis

The evolution of care for critically ill patients has saved many lives around the world.⁽⁾ Nevertheless, the increased number of survivors of critically ill episodes has also given rise to a substantial and expanding population of chronically critically ill patients (CCIP) who rely on mechanical ventilation (MV) support and other intensive care therapies for an extended period of time.^(–) The prolonged MV support and other prevalent conditions encountered during intensive care unit (ICU) hospitalization are associated with the development of clinical conditions that become a challenge for physical rehabilitation, such as peripheral muscle weakness and dysfunction of the diaphragm.^(–) However, in order to improve patients’ respiratory muscle strength, the inspiratory muscle training (IMT) is considered a good alternative, reducing symptoms like dyspnea, and possibly contributing to improving successful weaning rate.^(,) Although several studies showing the effectiveness of IMT in patients undergoing MV support have been published, its applicability to CCIP remains uncertain.

Objective:

The purpose was to assess whether inspiratory muscle training is associated with enhancements in muscle strength among CCIP.

Methods:

This review was performed following the PRISMA guidelines,^(,) and the methodological recommendations of the Cochrane Collaboration Handbook.⁽⁾ MEDLINE, Embase, Cochrane Central, and LILACS, Clinical Trials Registry, and World Health Organization databases performed on November 24, 2022, and updated on July 11, 2023. Titles and abstracts were screened independently and in duplicate to identify potentially eligible studies, and then a full text was utilized for eligibility. Characteristics and outcome data from included studies were independently extracted by two investigators and revised by a third investigator, using a data collection form for outcomes previously defined. For analysis, the RevMan V5.4 software was used, adopting the mean difference or standardized mean difference with 95% confidence interval (95%CI) for continuous variables or risk ratio with 95% CI for dichotomous outcomes. The GRADE system was used to measure and summarize the overall certainty of the current evidence of each outcome.

Results:

A total of 6,867 records were identified through the initial search, and after excluding duplicates, 6,304 unique reports were screened. Following the assessments of titles, abstracts, and full texts, 16 reports from 7 studies were included in this systematic review, with a total of 434 participants. The IMT showed a significant increase in the inspiratory muscle strength comparing IMT versus usual care, mean difference −8.37 (95%CI=-15.21 to −1.52), with very low certainty of evidence.

Conclusion:

IMT has demonstrated an association with better outcomes of inspiratory muscle strength compared to usual care and sham groups.

Inspiratory muscle training for chronic critically ill patients: a systematic review and meta-analysis

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