Diaphragm Ultrasonography, Inspiratory Muscle Training, Intensive Care Patients Invasively Ventilated, Mechanical Ventilation
Conditions
Keywords
Physiotherapy and Rehabilitation, Inspiratory Muscle Training, Ultrasound of Diaphragm, Intensive Care Unit, Mechanical Ventilation
Brief summary
In addition to conventional chest physiotherapy, inspiratory muscle training will be applied in mechanically ventilated intensive care patients. It is aimed to examine the effects of inspiratory muscle training on respiratory muscle strength, diaphragm thickness, and diaphragm excursion in intubated or tracheostomized patients with mechanical ventilation in the intensive care unit.
Detailed description
Subjects who mechanically ventilated in the intensive care unit will be divided two groups. Study group will recieve inspiratory muscle training in addition to convantional chest physiotherapy. Control group will recieve convantional chest physiotherapy. Training will continue until discharge or until the 21st day of the training. Respiratory muscle strength, diaphragm thickness and diaphragm excursion were measured before training and before discharge.
Interventions
DEVICEinspiratory muscle training
Inspiratory muscle training with a pressure-adjustable device
OTHERConvantional chest physiotherapy
Chest physiotherapy
Sponsors
Pamukkale University
Afyonkarahisar Health Sciences University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ≥18 years of age * hemodynamic stability and alert * able to spontaneously trigger the ventilator and perform at least one command for activation of respiratory muscles * required mechanical ventilation support with continuous spontaneous ventilation mode or pressure- or volume-controlled intermittent mandatory ventilation (6 breaths/min) mode * required pressure support ≤ 15 cmH2O and PEEP ≤ 10 cmH2O * unable to breathe without support for 72 consecutive hours following the resolution of factors leading to respiratory failure * FiO2 of 0.5 or less * PaO2 greater than 60 mmHg and capable of sufficient gas exchange
Exclusion criteria
* cooperation disorder * trauma or deformity related to the thorax that affect respiration * progressive neuromuscular disease * excessive bronchial secretion (requiring more than one suctioning per hour) * need for continued sedative or analgesic agents * use of home-type mechanical ventilation before admission to the hospital * cardiac, pulmonary, or other conditions leading to impaired stability * impaired cooperation, compliance, and motivation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Respiratory muscle strengh | 20 minutes | Respiratory muscle strength was measured as maximal inspiratory pressure. |
| Diaphragm thickness | 15 minutes | Diaphragm thickness was evaluated using ultrasound imaging in two-dimensional B mode (4-13 MHz) performed from the midaxillary level from the right intercostal space with patients sitting in a position as upright as possible. The thickness of the diaphragm was ensured with the superficial probe at end-inspiration (Tins) and end-expiration (Texp). |
| Diaphragm excursion | 20 | Diaphragm excursion was evaluated at the midaxillary level from the right subcostal area with M-mode (2-5 MHz) ultrasonography in normal inspiration and deep inspiration. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Physical Function in Intensive Care Test (PFIT) | 20 minutes | The PFIT is a test battery applied by the researchers that consists of four main headings: Support (from sitting to standing up), Cadence (steps/minute), Shoulder (flexion strength), and Knee (extension strength). Stand up from sitting was scored according to the degree of help received (0 = without help, 1 = with the help of one person, 2 = with the help of two people). We recorded standstill as the number of steps and the time elapsed while the standing still action was performed. Shoulder and knee muscle strength were assessed using a manual muscle test (0 = no contraction, 1 = contraction only, 2 = movement completed when gravity is eliminated, 3 = movement completed against gravity, 4 = movement completed with less than maximum resistance to gravity, 5 = movement completed with maximum resistance to gravity) |
| Rate of discharge from the intensive care unit | 8-21 days | Discharge rate of patients included in the study from intensive care unit |
| Duration of intubation | 3-15 days | After the subjects were included in the study duration of intubation was recorded. |
| Extubation rate | 3-15 days | Weaning rates of patients from mechanical ventilation |
Countries
Turkey (Türkiye)
Outcome results
None listed