Abstract
Background: Weaning failure are complex outcomes as it involves some aspects including weakness of the respiratory muscles. Ventilator-induced diaphragmatic dysfunction has been described as one of the main complications of IMV. Inspiratory muscle training with moderate loads was described in adults as having excellent results in terms of disconnection from the IMV literature. On pediatric population there is still a scarcity of and most of it consists of descriptions of isolated case reports. Methods: This study aims at evaluating whether muscle training using moderate loads will cause an increase in maximal inspiratory pressure (PIMAX) in patients dependent on mechanical ventilation. This is a retrospective study conducted in 2 Pediatric Intensive Care Units from January 2016 to December 2017. All patients who underwent muscle training during the period of the study were included. PIMAX was measured using a manovacuometer. Three measurements were made with an occlusion time of 15 seconds and a recovery interval of 2 minutes between them. Muscle training was performed following the institutional protocol (4 sets of 6 repetitions with a load equivalent to 60% of PIMAX) 1x/day, 6 days a week, excluding the day of the measurement of PIMAX. Results: Six patients undergoing prolonged mechanical ventilation (average time of mechanical ventilation of 9647 hours) who underwent muscle training to disconnect mechanical ventilation were included. The measurements of PIMAX pre-training were compared to weeks 1 to 4. A significant difference on PIMAX was observed after the second week of training (p <0.001). Five patients progressed to IMV disconnection. Conclusion: Our study supports the performance of IMT using moderate loads (60%), with no risk of muscle fatigue as it resulted in a significant increase in PIMAX after 2 weeks of training, with positive outcomes regarding weaning from mechanical ventilation.
Inspiratory Muscle Training in Patients With Prolonged Mechanical Ventilation