Inspiratory muscle training in weaning from prolonged mechanical ventilation: a systematic review and meta-analysis

Abstract

Prolonged mechanical ventilation in intensive care unit (ICU) patients poses significant challenges, including increased morbidity and healthcare costs. Effective weaning strategies are critical to improving patient's outcomes, yet the optimal approach remains unclear. Inspiratory muscle training (IMT) has emerged as a potential adjunct therapy to facilitate weaning, addressing the gap in standardized interventions. This systematic review and meta-analysis evaluate the effectiveness of IMT on weaning from mechanical ventilation in ICU patients. Seven randomized controlled trials published since 2019 were analyzed, comparing various IMT protocols. The findings support that high-intensity IMT can enhance extubation success rates and reduce the duration of mechanical ventilation. However, considerable variability in protocols and patient populations limits the generalizability of these findings. The findings underscore the urgent need for further research to standardize IMT protocols and to identify the patient subgroups most likely to benefit. Future studies should focus on refining methodologies and developing consensus-based guidelines to maximize the effectiveness of IMT in ICU settings. This review highlights the potential of IMT as a targeted strategy to improve weaning outcomes, reinforcing the importance of advancing evidence-based practices in critical care. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD420251070529.