| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Case Reports |
SS Sprague, PT, BHSc, is a physical therapist in private practice in Gainesville, Fla.
PD Hopkins, PT, BHSc, is a physical therapist in private practice in Gainesville, Fla
Address all correspondence to Mr Sprague at 15914 N State Road 121, Gainesville, FL 32653-7690 (USA) (ssocratessprague{at}yahoo.com)
Background and Purpose. Patients who are unable to wean from mechanical ventilation (MV) after resolution of critical illness or surgery risk increased morbidity and death and consume a disproportionate amount of intensive care unit resources. Decreased inspiratory muscle strength is often cited as a major factor contributing to prolonged MV. The purpose of this case report is to describe the rationale and application of inspiratory strength training (IST) as an adjunct to lengthen unassisted breathing trials and to ultimately wean patients with chronic mechanical ventilator dependency. Case Description. Six patients who had been ventilator-dependent for 18 to 221 days (mean of 72 days) after surgery and were diagnosed with "failure to wean" performed low-repetition, high-resistance breathing exercises that were coupled with increasing time off the ventilator. Outcomes. All 6 patients were weaned from the ventilator in 9 to 28 days (mean of 17 days). The patients' training pressure increased from a mean of 9.3 cm/H2O to 27.5 cm/H2O, for an increase of 195%. The volitional maximum inspiratory pressure (MIP) increased from a mean of 22.5 cm/H2O to 54 cm/H2O, for a 140% gain in pressure. Discussion. Although it is not clear why the patients appeared to benefit from IST, possible explanations include: (1) addressing inspiratory muscle pump dysfunction, (2) standardization of breathing patterns, 3) routinization of the patients' unassisted breathing trials, and (4) nonspecific training effects. Future research should address these possibilities when attempting to understand the effects of IST in the weaning of patients with chronic ventilator dependency.
Key Words: Dyspnea • Inspiratory muscle training • Inspiratory strength training • Pulmonary rehabilitation • Weaning from mechanical ventilation
This article has been cited by other articles:
|
|
 |
|
  J. Choi, F. J. Tasota, and L. A. Hoffman Mobility Interventions to Improve Outcomes in Patients Undergoing Prolonged Mechanical Ventilation: A Review of the Literature Biol Res Nurs, July 1, 2008; 10(1): 21 - 33. [Abstract] [PDF]
|
|
|
|
 |
|
 L.-L. Chiang, L.-Y. Wang, C.-P. Wu, H.-D. Wu, and Y.-T. Wu Effects of Physical Training on Functional Status in Patients With Prolonged Mechanical Ventilation Physical Therapy, September 1, 2006; 86(9): 1271 - 1281. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Vitacca, M. Paneroni, L. Bianchi, E. Clini, A. Vianello, P. Ceriana, L. Barbano, B. Balbi, and S. Nava Maximal inspiratory and expiratory pressure measurement in tracheotomised patients Eur. Respir. J., February 1, 2006; 27(2): 343 - 349. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. R. MacIntyre, S. K. Epstein, S. Carson, D. Scheinhorn, K. Christopher, and S. Muldoon Management of Patients Requiring Prolonged Mechanical Ventilation: Report of a NAMDRC Consensus Conference Chest, December 1, 2005; 128(6): 3937 - 3954. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A. d. F. Fregonezi, V. R. Resqueti, R. Guell, J. Pradas, and P. Casan Effects of 8-Week, Interval-Based Inspiratory Muscle Training and Breathing Retraining in Patients With Generalized Myasthenia Gravis Chest, September 1, 2005; 128(3): 1524 - 1530. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
