Patients who failed simple weaning from mechanical ventilation. Inspiratory muscle training Early mobilization Body composition Physical therapy Intensive care Weaning failure
Conditions
Interventions
1. IMT: Using an inspiratory training device (POWERbreathe KH2) with a load 40-
60% of the daily participant’s maximal inspiratory pressure. Each training session consists of 30 breaths twice a day,
seven days a week. Supplementary oxygen if need during a training session. The training session will be stopped if participants present adverse signs (respiratory rate more than 35 breaths/min,
arterial saturation less than 90%,
systolic pressure above 180 mmHg or below 80 mmHg,
heart rate more than 140 beats/min or 20% higher than at the start,
paradoxical breathing,
hemoptysis,
depression,
or sweating.
2. EM Program: After testing the muscle strength,
early mobilization program will be performed according to patients’ starting level. The program is divided into three levels.
Level I
Testing: Good consciousness & follow simple command for upright position on bed
Training: 1. Active-
assisted ROM exercise or active ROM exercise of UE & LE 5-
10 times,
2 rounds/day
2. Sitting balance training
Level II
Testing: MMT of biceps & triceps brachii muscle grade > 3/5 (MRC scoring) & sitting balance testing at least fair grade for sitting on the edge of the bed
Training: 1. UE: resisted exercise (weight â
2 rounds/day
2. LE: active exercise 5-
Sponsors
Faculty of Associated Medical Sciences, Chiang Mai University
Faculty of Associated Medical Sciences,
Chiang Mai University
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: 1. Participants aged 18 years old or more who will have to undergo mechanical ventilation via endotracheal tube and failed simple weaning. 2. Good consciousness and cooperation 3. Hemodynamic stable (no hypotension, SBP between 90-170 mmHg, MAP not varying by > 10 mmHg, Oxygen saturation > 92%, no need vasopressor or use very low levels) 4. Respiratory stable (FiO2 < 0.60, no use respiratory-depressant drugs) 5. No active sepsis 6. No hyperthermia 7. Underlying disease stable and causes for respiratory failure are resolved 8. Psychologically stable
Exclusion criteria
Exclusion criteria: 1. Insufficient chronic congestive heart failure, life-threatening cardiac arrhythmias, cardiovascular instability 2. End stage of lung cancer 3. Neurological disease (cerebral vascular accident, cerebrospinal trauma, spinal medullar trauma, myopathy) 4. Severe orthopedic problems, musculoskeletal pathology that impact chest movement 5. Endocrine system and metabolic system dysfunction (hypothyroidism, malnutrition) 6. Obesity (BMI ≥ 40 kg/m2) 7. Pregnancy 8. Significantly pain or distress experience that impeded in breathing capacity 9. Use attention disorder drugs and/or sedative agents 10. Palliation 11. Pre-ICU admission status; inability to walk without assistance (except using cane or walkers) 12 Cardiopulmonary resuscitation (CPR) at admission, do not resuscitate at admission 13. Readmission to ICU within current hospitalization
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Mechanical ventilation duration 48 hours after extubation Days/duration of mechanical ventilation will be recorded from the date of failed simple weaning to e | — |
Secondary
| Measure | Time frame |
|---|---|
| Maximal inspiratory pressure (MIP) Prior to treatment and 48 hours after extubation cmH2O/Forceful inspiratary pressure will be measured by using the POWERbreathe KH2 device. ,Limbs muscle force Prior to treatment and 48 hours after extubation kg/Limbs muscle forces will be measured by using a hand-held dynamometer (Lafayette).,Body composition Prior to treatment and 48 hours after extubation kg/Body composition will be measured by using InBodyS10. | — |
Countries
Thailand
Contacts
Public ContactMujalin Prasannarong
Outcome results
None listed