Comparing 2 loading types during inspiratory muscle training in difficult to wean patients

M. Van Hollebeke (Leuven, Belgium), S. Pleysier (Leuven, Belgium), D. Poddighe (Leuven, Belgium), L. Muelas Gómez (Madrid, Spain), Y. Qaiser Choudhary (Leuven, Belgium), B. Clerckx (Leuven, Belgium), J. Muller (Leuven, Belgium), G. Hermans (Leuven, Belgium), R. Gosselink (Leuven, Belgium), D. Langer (Leuven, Belgium)

Source: Respiratory Failure and Mechanical Ventilation Conference 2022 - Opening session: Essentials of respiratory physiology - Assessment of respiratory muscle function - Pulmonary infections in mechanically ventilated patients - Telemonitoring of patients with chronic respiratory failure - Diagnostics and interventions - Acute respiratory failure: COVID-19 - Interstitial lung disease and pulmonary hypertension - Early rehabilitation - Acute respiratory failure: Invasive mechanical ventilation - HFNO and NIV for acute hypoxemic failure - Longterm NIV miscellaneous - Controversies in acute respiratory failure - The role of respiratory muscle dysfunction in weaning failure - Transitions in chronic NIV - New insights in weaning from invasive ventilation - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Difficult weaning from mechanical ventilation - Chronic ventilatory support in different diseases: Is one way fitting all? - Strategies to optimise early mobilisation and rehabilitation in intensive care - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Acute respiratory failure: Hypercapnic and diagnosis - Weaning from mechanical ventilation

Session: Weaning from mechanical ventilation
Session type: Oral poster discussion
Number: 109

Abstract

Background: Tapered flow resistive loading (TFRL) better accommodates the pressure-volume relationships of the inspiratory muscles than the commonly used pressure threshold loading (TL). It is unclear if TFRL elicits different breathing pattern responses compared to TL in patients with weaning difficulties.

Aim: Compare acute breathing pattern and perceived symptoms in response to IMT sessions performed against equal initial inspiratory loading provided as either TL or TFRL in patients with weaning difficulties.

Method: 21 patients (52±16years) with maximal inspiratory pressure (PImax): 35±14cmH2O and FVC: 0.85L±0.37L, performed two IMT sessions against TL or TFRL with an initial load of 42±15%PImax. Breath-by-breath data of breathing parameters were collected and patients rated their perceived symptoms afterwards.

Results: For a given loading, TFRL allowed significantly larger inspiratory tidal volumes and inspiratory flow responses but inspiratory pressure was lower compared to TL. No differences in work of breathing or power were observed between the types of loading. Patients perceived TFRL as less unpleasant (Table 1).

Conclusion: For a given loading, TFRL-IMT allows larger volume expansion and higher inspiratory flow responses compared to TL-IMT and patients perceived TFRL as less unpleasant. This might facilitate early implementation of IMT and improve training outcomes in patients with weaning difficulties.

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M. Van Hollebeke (Leuven, Belgium), S. Pleysier (Leuven, Belgium), D. Poddighe (Leuven, Belgium), L. Muelas Gómez (Madrid, Spain), Y. Qaiser Choudhary (Leuven, Belgium), B. Clerckx (Leuven, Belgium), J. Muller (Leuven, Belgium), G. Hermans (Leuven, Belgium), R. Gosselink (Leuven, Belgium), D. Langer (Leuven, Belgium). Comparing 2 loading types during inspiratory muscle training in difficult to wean patients. Respiratory Failure and Mechanical Ventilation Conference 2022 - Opening session: Essentials of respiratory physiology - Assessment of respiratory muscle function - Pulmonary infections in mechanically ventilated patients - Telemonitoring of patients with chronic respiratory failure - Diagnostics and interventions - Acute respiratory failure: COVID-19 - Interstitial lung disease and pulmonary hypertension - Early rehabilitation - Acute respiratory failure: Invasive mechanical ventilation - HFNO and NIV for acute hypoxemic failure - Longterm NIV miscellaneous - Controversies in acute respiratory failure - The role of respiratory muscle dysfunction in weaning failure - Transitions in chronic NIV - New insights in weaning from invasive ventilation - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Difficult weaning from mechanical ventilation - Chronic ventilatory support in different diseases: Is one way fitting all? - Strategies to optimise early mobilisation and rehabilitation in intensive care - Noninvasive ventilation (NIV) in the clinical practice: How do I do it? - Acute respiratory failure: Hypercapnic and diagnosis - Weaning from mechanical ventilation

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