Background: Mechanical ventilation is a vital life-support technique used in the management of patients with respiratory impairment; however, its prolonged use can lead to muscular or systemic complications that can compromise the weaning process and the patient’s overall functional recovery. Respiratory physiotherapy, and in particular Inspiratory Muscle Training (IMT), play a central role in the rehabilitation of critically ill patients, aiming to preserve diaphragmatic function and promote the recovery of ventilatory autonomy. Objective: The aim of this narrative review is to identify and analyze the main scientific evidence concerning the effectiveness of respiratory physiotherapy in patients undergoing mechanical ventilation. Particular attention was given to IMT, assessing its impact on weaning and clinical outcomes. Materials and Methods: A narrative review of the scientific literature published between 2015 and 2025 was conducted using the PubMed database. Randomized controlled trials (RCTs), systematic reviews, and meta-analyses evaluating the efficacy of IMT in adult patients undergoing invasive mechanical ventilation were included. Pediatric studies, non-English articles, and studies involving specific populations (neuromuscular diseases, COPD, lung transplantation) were excluded. Ten studies, including four RCTs and six systematic reviews, were included in the final analysis. Results: Studies recognize IMT as a safe and well-tolerated intervention that can improve inspiratory muscle strength and reduce weaning time, especially when combined with conventional physiotherapy and other interventions such as early mobilization and non-invasive ventilation (NIV). No significant differences emerged in the overall duration of mechanical ventilation or mortality. However, the high heterogeneity of protocols and the variable methodological quality of the included studies limit the ability to draw definitive conclusions. Conclusions: IMT represents a promising and clinically relevant strategy in the rehabilitative management of mechanically ventilated patients. Further high-quality studies are needed to standardize its application and to evaluate its long-term effects. Keywords: Intensive Care Unit, respiratory physiotherapy, chest physiotherapy, ventilator weaning, weaning, inspiratory muscle training.
Background: La ventilazione meccanica è una tecnica di supporto vitale indispensabile nella gestione dei pazienti con compromissioni respiratorie, ma il suo utilizzo prolungato può portare a complicanze muscolari o sistemiche che compromettono il processo di svezzamento e il recupero funzionale globale del paziente. La fisioterapia respiratoria, e in particolare l’allenamento dei muscoli inspiratori (Inspiratory Muscle Training, IMT), rivestono un ruolo centrale nella riabilitazione del paziente critico e hanno l’obiettivo di preservare la funzione diaframmatica e favorire il recupero dell’autonomia ventilatoria. Obiettivo: Lo scopo della presente revisione narrativa è individuare e analizzare le principali evidenze scientifiche riguardanti l’efficacia della fisioterapia respiratoria nei pazienti sottoposti a ventilazione meccanica. Particolare attenzione è stata rivolta all’IMT, valutandone l’impatto sullo svezzamento e sugli esiti clinici. Materiali e metodi: È stata condotta una revisione narrativa della letteratura scientifica pubblicata dal 2015 al 2025, attraverso la banca dati PubMed. Sono stati inclusi studi randomizzati controllati (RCT), revisioni sistematiche e meta-analisi che valutavano l’efficacia dell’IMT nei pazienti adulti sottoposti a ventilazione meccanica invasiva. Sono stati esclusi studi pediatrici, articoli non in lingua inglese e studi su popolazioni con patologie specifiche (neuromuscolari, BPCO, trapianto polmonare). Dieci studi, di cui quattro RCT e sei revisioni sistematiche, sono stati inclusi nell’analisi finale. Risultati: Gli studi riconoscono che l’IMT è un intervento sicuro e ben tollerato, in grado di migliorare la forza dei muscoli inspiratori e di ridurre i tempi di svezzamento, soprattutto se integrato alla fisioterapia convenzionale e ad altri interventi come la mobilizzazione precoce e la ventilazione non invasiva (NIV). Non emergono, invece, differenze significative nella durata complessiva della MV o nella mortalità. Tuttavia, l’elevata eterogeneità dei protocolli e la qualità metodologica variabile degli studi analizzati limitano la possibilità di trarre conclusioni definitive. Conclusioni: L’IMT rappresenta una strategia promettente e clinicamente rilevante nella gestione riabilitativa del paziente ventilato meccanicamente. Sono tuttavia necessari ulteriori studi di alta qualità metodologica per uniformarne l’applicazione e valutarne gli effetti a lungo termine. Parole chiave: Unità di terapia intensiva, fisioterapia respiratoria, fisioterapia toracica, svezzamento dal ventilatore, svezzamento, allenamento dei muscoli inspiratori.
EFFICACIA DELL’INSPIRATORY MUSCLE TRAINING NEI PAZIENTI SOTTOPOSTI A VENTILAZIONE MECCANICA: UNA REVISIONE NARRATIVA DELLA LETTERATURA
CARDUCCI, GIORGIA
2024/2025
Abstract
Background: Mechanical ventilation is a vital life-support technique used in the management of patients with respiratory impairment; however, its prolonged use can lead to muscular or systemic complications that can compromise the weaning process and the patient’s overall functional recovery. Respiratory physiotherapy, and in particular Inspiratory Muscle Training (IMT), play a central role in the rehabilitation of critically ill patients, aiming to preserve diaphragmatic function and promote the recovery of ventilatory autonomy. Objective: The aim of this narrative review is to identify and analyze the main scientific evidence concerning the effectiveness of respiratory physiotherapy in patients undergoing mechanical ventilation. Particular attention was given to IMT, assessing its impact on weaning and clinical outcomes. Materials and Methods: A narrative review of the scientific literature published between 2015 and 2025 was conducted using the PubMed database. Randomized controlled trials (RCTs), systematic reviews, and meta-analyses evaluating the efficacy of IMT in adult patients undergoing invasive mechanical ventilation were included. Pediatric studies, non-English articles, and studies involving specific populations (neuromuscular diseases, COPD, lung transplantation) were excluded. Ten studies, including four RCTs and six systematic reviews, were included in the final analysis. Results: Studies recognize IMT as a safe and well-tolerated intervention that can improve inspiratory muscle strength and reduce weaning time, especially when combined with conventional physiotherapy and other interventions such as early mobilization and non-invasive ventilation (NIV). No significant differences emerged in the overall duration of mechanical ventilation or mortality. However, the high heterogeneity of protocols and the variable methodological quality of the included studies limit the ability to draw definitive conclusions. Conclusions: IMT represents a promising and clinically relevant strategy in the rehabilitative management of mechanically ventilated patients. Further high-quality studies are needed to standardize its application and to evaluate its long-term effects. Keywords: Intensive Care Unit, respiratory physiotherapy, chest physiotherapy, ventilator weaning, weaning, inspiratory muscle training.I documenti in UNITESI sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
https://hdl.handle.net/20.500.12075/23770