Background: Evaluation and training of the respiratory muscles are essential to reducing time of weaning invasive mechanical ventilation (VMI) in intensive care units (ICU). Powerbreathe® is indicated for inspiratory muscle training (IMT) with a progressive resistance and adjustable load in respiratory disease patients. Objective: Compare the inspiratory muscle strength between two groups of tracheostomy patients: IMT with Powerbreathe® and breathing through a humidified t-piece (T-tube). Methods: 25 tracheostomy patients were selected under VMI and randomized into two groups: T-tube (control) and IMT with Powerbreathe®. Patients of both groups received respiratory physical therapy and the MIP measurements with a digital manometer (MVD300, Globalmed®), with a one-way valve connected to tracheostomy, with occlusion for 20 seconds. In control group patients underwent T-tube until complete 48 hours of continuous nebulization. In the IMT group was used Powerbreathe® KH2 model (Powerbreathe®, IMT Technologies Ltd., Birmingham, England) for 30 cycles (three sets of 10 cycles with 1 minute interval between them), adjusted load 30% of the initial MIP, increasing 10% daily. For statistical analysis, were applied Wilcoxon test for comparison of related and Mann-Whitney test for independent samples variables. P values <0.05 were considered statistically significant. Results: Of 19 patients, 8 in the IMT group with 7 men and 11 in the control, with 8 men. Were increased final MIP compared to initial in IMT group (p=0.017), with no significant difference for the control group (p=0.304). Conclusion: The IMT with Powerbreathe® in tracheostomy patients promotes increased muscle strength.

BACKGROUND: Esophageal resection is associated with a high incidence of postoperative pneumonia. Respiratory complications account for almost half of the readmissions to the critical care unit. Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs. In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay. While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection, the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical populations other than cardiac surgery in a randomized and controlled study design.
METHODS/DESIGN: The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter randomized controlled trial (the PREPARE study). In total 248 patients (age >18 years) undergoing esophageal resection for esophageal cancer will be included in this study. They are randomized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device. Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks. The starting training load will be aimed to be 60% of maximal inspiratory pressure and will be increased based on the rate of perceived exertion.The main study endpoint is the incidence of postoperative pneumonia. Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay, duration of mechanical ventilation, incidence of other postoperative (pulmonary) complications, quality of life, and on postoperative respiratory muscle function and lung function.
DISCUSSION: The PREPARE study is the first multicenter randomized controlled trial to evaluate the hypothesis that preoperative inspiratory muscle training leads to decreased pulmonary complications in patients undergoing esophageal resection.
PMID: 24767575 PMCID: PMC4019558 DOI: 10.1186/1745-6215-15-144

Definitely, mechanical ventilation (MV) is a life-saving treatment in the intensive care unit (ICU), but it is also a double-edged sword. Forty percent of the overall time spent in the ICU was reported to be devoted to weaning of MV. The major cause of weaning failure is the imbalance between the imposed load on the respiratory system and its capacity to overcome that. Thus, since the 1980’s numerous studies with inspiratory muscle training (IMT) have been conducted in an attempt to reduce weaning and MV time in prolonged mechanically ventilated patients. Despite dozens of published research, only 5 randomized controlled trials (RCT) were conducted until this date. Nevertheless, it was not yet clear whether IMT led to a shorter duration of mechanical ventilation, improved weaning success, or improved survival. These RCT show considerable heterogeneity among them and possible bias that could have impaired their results. Thus, some questions may be made to highlight main points: What is the ideal prescription of IMT for patients on MV? What is the best time to measure treatment effect? Which kind of device should be used to IMT? What are the best endpoints to evaluate the effects of IMT on the process of discontinuing from MV? IMT on mechanically ventilated patients seems to be a promissory treatment despite controversial results. Therefore, RCTs should be carried out to verify the efficacy of new protocols in different approaches.
Keywords: Breathing exercises; Extubation; Inspiratory muscle training; Physiotherapy; Ventilator dependence; Ventilator weaning.

BACKGROUND: The purpose of this study was to examine the inter- and intra-rater reliability of an electronic inspiratory loading device for the assessment of pulmonary functions: maximum inspiratory pressure, peak inspiratory flow, and vital capacity.
MATERIAL/METHODS: Subjects were 50 patient volunteers in a rehabilitation hospital who had experienced their first episode of unilateral stroke with hemiparesis during the previous 6 months (26 men, 24 women; mean age [±SD], 55.96 [±12.81] years), with no use of medications that could induce drowsiness, evidence of restrictive lung disease, history of asthma, use of psychotropic drugs, or alcohol consumption habit. Maximum inspiratory pressure, peak inspiratory flow, and vital capacity for pulmonary functions were assessed using an electronic inspiratory loading device (PowerBreathe, K5, 2010) by 2 examiners, with patients in an unassisted sitting position, and 1 examiner re-assessed with same patients at the same time of a day after 1 week. Intra-class correlation coefficients were used to assess reliability.
RESULTS: Intra-rater reliability ranged from intra-class correlation coefficients (ICCs)=0.959 to 0.986 in variables. For the inter-rater reliability between 2 examiners, the ICCs ranged from 0.933 to 0.985. Intra-rater and inter-rater reliability were good in variables (maximal inspiratory pressure, peak inspiratory flow, and vital capacity).
CONCLUSIONS: The intra- and inter-examiner reliability of the pulmonary function measurements, maximum inspiratory pressure, peak inspiratory flow, and vital capacity, for the post-stroke patients was very high. The results suggest that the electronic inspiratory loading device would be useful for clinical rehabilitative assessment of pulmonary function.
PMID: 26782369 PMCID: PMC4725617 DOI: 10.12659/msm.895573

Background: Evaluation and training of the respiratory muscles are essential to reducing time of weaning invasive mechanical ventilation (VMI) in intensive care units (ICU). Powerbreathe® is indicated for inspiratory muscle training (IMT) with a progressive resistance and adjustable load in respiratory disease patients. Objective: Compare the inspiratory muscle strength between two groups of tracheostomy patients: IMT with Powerbreathe® and breathing through a humidified t-piece (T-tube). Methods: 25 tracheostomy patients were selected under VMI and randomized into two groups: T-tube (control) and IMT with Powerbreathe®. Patients of both groups received respiratory physical therapy and the MIP measurements with a digital manometer (MVD300, Globalmed®), with a one-way valve connected to tracheostomy, with occlusion for 20 seconds. In control group patients underwent T-tube until complete 48 hours of continuous nebulization. In the IMT group was used Powerbreathe® KH2 model (Powerbreathe®, IMT Technologies Ltd., Birmingham, England) for 30 cycles (three sets of 10 cycles with 1 minute interval between them), adjusted load 30% of the initial MIP, increasing 10% daily. For statistical analysis, were applied Wilcoxon test for comparison of related and Mann-Whitney test for independent samples variables. P values <0.05 were considered statistically significant. Results: Of 19 patients, 8 in the IMT group with 7 men and 11 in the control, with 8 men. Were increased final MIP compared to initial in IMT group (p=0.017), with no significant difference for the control group (p=0.304). Conclusion: The IMT with Powerbreathe® in tracheostomy patients promotes increased muscle strength.