Inspiratory Muscle Training as an Adjunct to the Treatment of Weaning Failure in Critically Ill Patients: A Practical Guide

Inspiratory muscle weakness is common among mechanically ventilated patients and is a well-recognized contributor to weaning difficulties, which are associated with poor outcomes and increased mortality. Inspiratory muscle training is a feasible and promising intervention that can improve global respiratory muscle strength and potentially facilitate successful liberation from mechanical ventilation in patients with weaning difficulties. This article proposes a practical guide supporting clinicians in integrating inspiratory muscle training into the care of mechanically ventilated patients experiencing weaning difficulties, informed by clinical experience and current evidence. The proposed approach focuses on the application of inspiratory muscle training in patients with weaning difficulties (mostly tracheostomized patients undergoing prolonged weaning), who fulfill readiness-to-wean criteria and are fully cooperative. Training sessions are typically conducted daily while the patient is disconnected from the ventilator, following an initial assessment of maximal inspiratory pressure and forced vital capacity. These parameters, along with volume displacement observed during each training session and symptom scores evaluated afterward, are used to individualize the initial external load and training progression. The main components that are taken into account to offer and individualize the training approach include patient selection, respiratory muscle and lung function assessment, load setting modalities, breathing instructions during training, and training progression guided by symptom scores and volume displacement.