Inspiratory muscle training in intensive care unit patients: A Systematic review

  • Nurul Imam Sekolah Tinggi Ilmu Kesehatan William Booth Surabaya, East Java, Indonesia
  • Taufan Citra Darmawan Sekolah Tinggi Ilmu Kesehatan William Booth Surabaya, East Java, Indonesia https://orcid.org/0000-0001-8912-9481
  • Khalifatus Zuhriyah Alfianti Fakultas Kesehatan, Universitas Gresik, East Java, Indonesia https://orcid.org/0009-0007-6311-2682
  • Welmince Paulina Nggorong Sekolah Tinggi Ilmu Kesehatan Maranatha Kupang, Nusa Tenggara Timur, Indonesia
  • Ananda Patuh Padaallah Fakultas Ilmu Kesehatan, Universitas Medika Suherman, Kabupaten Bekasi, West Java, Indonesia
Keywords: Intensive care unit, inspiratory muscle training, respiratory

Abstract

Critical patients with ICU room treatment have high morbidity and mortality. Prolonged use of mechanical ventilation can result in a reduction in the strength of the respiratory muscles. The purpose of this review article is to explain the effectiveness of the implementation of IMT in Intensive Care Unit patients. The research design used the PRISMA guideline with a literature search strategy on the Scopus database (n=10), ProQuest (n=1), Web of Science (n=913), PubMed (n=291), and Google Scholar (n=800), with the keyword "Inspiratory Muscle Training OR IMT AND Intensive Care Unit OR ICU AND Breathing AND Ventilation". The selected articles used the Randomized Control Trial and Quasi-Experimental, Case, and Observational Cohort Study research designs. The year the source of the literature was taken is 2020-2024. The effectiveness of Inspiratory Muscle Training also depends on several factors, including the patient's specific health condition, the type of disease or injury, and the implementation and supervision of the exercise program. One of the benefits of IMT is increased respiratory muscle strength, reduced duration of mechanical ventilation, reduced risk of respiratory complications, and improved quality of life. Inspiratory Muscle Training (IMT) has shown effectiveness in various clinical contexts, including the ICU.

References

Bissett, B., Leditschke, I. A., Green, M., Marzano, V., Collins, S., & Van Haren, F. (2019). Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Australian Critical Care, 32(3), 249–255. https://doi.org/10.1016/j.aucc.2018.06.001

Bissett, B. M., Leditschke, I. A., Neeman, T., Boots, R., & Paratz, J. (2016a). Inspiratory muscle training to enhance recovery from mechanical ventilation: A randomized trial. Thorax, 71(9), 812–819. https://doi.org/10.1136/thoraxjnl-2016-208279

Bissett, B. M., Leditschke, I. A., Neeman, T., Green, M., Marzano, V., Erwin, K., van Haren, F. M. P., Boots, R., & Paratz, J. (2023). Does mechanical threshold inspiratory muscle training promote recovery and improve outcomes in patients who are ventilator-dependent in the intensive care unit? The IMPROVE randomised trial. Australian Critical Care, 36(4), 613–621. https://doi.org/https://doi.org/10.1016/j.aucc.2022.07.002

Bissett, B. M., Wang, J., Neeman, T., Leditschke, I. A., Boots, R., & Paratz, J. (2020). Which ICU patients benefit most from inspiratory muscle training? Retrospective analysis of a randomized trial. Physiotherapy Theory And Practice, 36(12), 1316–1321. https://doi.org/10.1080/09593985.2019.1571144

Bureau, C., Hollebeke, M. Van, & Dres, M. (2023). Managing respiratory muscle weakness during weaning from invasive ventilation. European Respiratory Review, 32(168). https://doi.org/10.1183/16000617.0205-2022

Clayton, N. A., Ward, E. C., Nicholls, C., Giannone, R., Skylas, K., & Maitz, P. K. (2022). The addition of respiratory muscle strength training to facilitate swallow and pulmonary rehabilitation following massive tissue loss and severe deconditioning: A case series. Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses, 35(2), 210–216. https://doi.org/10.1016/j.aucc.2021.03.003

da Silva Guimarães, B., de Souza, L. C., Cordeiro, H. F., Regis, T. L., Leite, C. A., Puga, F. P., Alvim, S. H., & Lugon, J. R. (2021). Inspiratory Muscle Training With an Electronic Resistive Loading Device Improves Prolonged Weaning Outcomes in a Randomized Controlled Trial*. Critical Care Medicine, 49(4). https://journals.lww.com/ccmjournal/fulltext/2021/04000/inspiratory_muscle_training_with_an_electronic.4.aspx

Epstein, S. K. (2001). Controversies in Weaning from Mechanical Ventilation. Journal of Intensive Care Medicine, 16(6), 270–286. https://doi.org/10.1046/j.1525-1489.2001.00270.x

Hearn, E., Gosselink, R., Freene, N., Boden, I., Green, M., & Bissett, B. (2022). Inspiratory muscle training in intensive care unit patients: An international cross-sectional survey of physiotherapist practice. AUSTRALIAN CRITICAL CARE, 35(5), 527–534. https://doi.org/10.1016/j.aucc.2021.08.002

Jenkins, T. O., MacBean, V., Poulsen, M. K., Karbing, D. S., Rees, S. E., Patel, B. V., & Polkey, M. I. (2023). The metabolic cost of inspiratory muscle training in mechanically ventilated patients in critical care. Intensive Care Medicine Experimental, 11(1). https://doi.org/10.1186/s40635-023-00522-6

Kaygusuz Benli, R., Yurdalan, U., Yılmaz, B., & Adıgüzel, N. (2024). Effect of post-extubation inspiratory muscle training on diaphragmatic function in mechanically ventilated patients: A randomized controlled trial. Advances in Clinical and Experimental Medicine, 33(10), 0–0. https://doi.org/10.17219/acem/174815

Kazemi, M., Froutan, R., & Moghadam, A. B. (2024). Impact of Inspiratory Muscle Training and Positive Expiratory Pressure on Lung Function and Extubation Success of ICU Patients: A Randomized Controlled Trial. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE, 12(1). https://doi.org/10.22037/aaem.v12i1.2331

Khodabandeloo, F., Froutan, R., Yazdi, A. P., Shakeri, M. T., Mazlom, S. R., & Moghaddam, A. B. (2023). The effect of threshold inspiratory muscle training on the duration of weaning in intensive care unit-admitted patients: A randomized clinical trial. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, 28, 44. https://doi.org/10.4103/jrms.jrms_757_22

Kurnianto, S., Astuti, A., Endro Sulistyono, R., & Cahyo Putri, M. (2022). Changes in Respiratory Function in Asthma Patients using Respiratory Inspiration Muscle Exercise: Literature Review. Nursing and Health Sciences Journal (NHSJ), 2(2), 179–182. https://doi.org/10.53713/nhs.v2i2.126

Lage, S. M., Pereira, D. A. G., Corradi Magalhaes Nepomuceno, A. L., de Castro, A. C., Araujo, A. G., Hoffman, M., Silveira, B. M. F., & Parreira, V. F. (2021). Efficacy of inspiratory muscle training on inspiratory muscle function, functional capacity, and quality of life in patients with asthma: A randomized controlled trial. CLINICAL REHABILITATION, 35(6), 870–881. https://doi.org/10.1177/0269215520984047

Langer, D., Ciavaglia, C., Faisal, A., Webb, K. A., Neder, J. A., Gosselink, R., Dacha, S., Topalovic, M., Ivanova, A., & O’Donnell, D. E. (2018). Inspiratory muscle training reduces diaphragm activation and dyspnea during exercise in COPD. Journal of Applied Physiology (Bethesda, Md. : 1985), 125(2), 381–392. https://doi.org/10.1152/japplphysiol.01078.2017

Major, M. E., Sommers, J., Horrevorts, E., Buist, C. M., Dettling-Ihnenfeldt, D. S., & van der Schaaf, M. (2024). Inspiratory muscle training for mechanically ventilated patients in the intensive care unit: Obstacles and facilitators for implementation. A mixed method quality improvement study. Australian Critical Care, xxxx, 1–8. https://doi.org/10.1016/j.aucc.2024.01.005

Martin, A. D., Smith, B. K., Davenport, P. D., Harman, E., Gonzalez-Rothi, R. J., Baz, M., Layon, A. J., Banner, M. J., Caruso, L. J., Deoghare, H., Huang, T.-T., & Gabrielli, A. (2011). Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Critical Care (London, England), 15(2), R84. https://doi.org/10.1186/cc10081

Medrinal, C., Combret, Y., Prieur, G., Robledo Quesada, A., Bonnevie, T., Gravier, F. E., Dupuis Lozeron, E., Frenoy, E., Contal, O., & Lamia, B. (2018). Comparison of exercise intensity during four early rehabilitation techniques in sedated and ventilated patients in ICU: a randomised cross-over trial. Critical Care (London, England), 22(1), 110. https://doi.org/10.1186/s13054-018-2030-0

Patricia T.G.S., & Eva Vanya Theresia Br Tarigan. (2024). Analisis Indikator Rasio Angka Kematian di Ruang ICU/ICCU pada Rumah Sakit. Sehat Rakyat: Jurnal Kesehatan Masyarakat, 3(1), 14–24. https://doi.org/10.54259/sehatrakyat.v3i1.2151

Petrof, B. J. (2018). Diaphragm Weakness in the Critically Ill: Basic Mechanisms Reveal Therapeutic Opportunities. Chest, 154(6), 1395–1403. https://doi.org/10.1016/j.chest.2018.08.1028

Purba, W. S. H. (2021). Pengaruh Inspiratory Muscle Training Terhadap Status Respirasi Pada Penyakit Paru Obstuktif Kronik. Al-Asalmiya Nursing: Jurnal Ilmu Keperawatan (Journal of Nursing Sciences), 10(2), 71–77. https://doi.org/10.35328/keperawatan.v10i2.2095

Reginault, T., Alejos, R. M., Coueron, R., Burle, J., Boyer, A., Frison, E., & Vargas, F. (2024). Impacts of three inspiratory muscle training programs on inspiratory muscles strength and endurance among intubated and mechanically ventilated patients with difficult weaning: a multicentre randomised controlled trial. JOURNAL OF INTENSIVE CARE, 12(1). https://doi.org/10.1186/s40560-024-00741-3

Tobin, M. J., Laghi, F., & Jubran, A. (2010). Narrative review: ventilator-induced respiratory muscle weakness. Annals of Internal Medicine, 153(4), 240–245. https://doi.org/10.7326/0003-4819-153-4-201008170-00006

Tonella, R. M., Ratti, L. D. S. R., Delazari, L. E. B., Junior, C. F., Da Silva, P. L., Herran, A. R. D. S., Dos Santos Faez, D. C., Saad, I. A. B., De Figueiredo, L. C., Moreno, R., Dragosvac, D., & Falcao, A. L. E. (2017). Inspiratory Muscle Training in the Intensive Care Unit: A New Perspective. Journal of Clinical Medicine Research, 9(11), 929–934. https://doi.org/10.14740/jocmr3169w

Van Hollebeke, M., Poddighe, D., Clerckx, B., Muller, J., Hermans, G., Gosselink, R., Langer, D., & Louvaris, Z. (2022). High-Intensity Inspiratory Muscle Training Improves Scalene and Sternocleidomastoid Muscle Oxygenation Parameters in Patients With Weaning Difficulties: A Randomized Controlled Trial. FRONTIERS IN PHYSIOLOGY, 13. https://doi.org/10.3389/fphys.2022.786575

Yodang, Y., & Nuridah, N. (2020). The effectiveness of inspiratory muscle training in improving respiratory functional in COPD patients. Jurnal Aisyah : Jurnal Ilmu Kesehatan, 5(2), 225–228. https://doi.org/10.30604/jika.v5i2.388

Published
2025-03-06
How to Cite
1.
Nurul Imam, Taufan Citra Darmawan, Khalifatus Zuhriyah Alfianti, Welmince Paulina Nggorong, Ananda Patuh Padaallah. Inspiratory muscle training in intensive care unit patients: A Systematic review. NHSJ [Internet]. 2025Mar.6 [cited 2025Mar.16];5(1):17-6. Available from: http://nhs-journal.com/index.php/nhs/article/view/446
Section
Articles