High-Intensity Inspiratory Muscle Training Improves Scalene and Sternocleidomastoid Muscle Oxygenation Parameters in Patients With Weaning Difficulties: A Randomized Controlled Trial

Marine Van Hollebeke; Diego Poddighe; Beatrix Clerckx; Jan Muller; Greet Hermans; Rik Gosselink; Daniel Langer; Zafeiris Louvaris

doi:10.3389/fphys.2022.786575

High-Intensity Inspiratory Muscle Training Improves Scalene and Sternocleidomastoid Muscle Oxygenation Parameters in Patients With Weaning Difficulties: A Randomized Controlled Trial

Front Physiol. 2022 Feb 9:13:786575. doi: 10.3389/fphys.2022.786575. eCollection 2022.

Authors

Marine Van Hollebeke^{1

2}, Diego Poddighe^{1

2}, Beatrix Clerckx², Jan Muller², Greet Hermans^{2

3}, Rik Gosselink^{1

2}, Daniel Langer^{1

2}, Zafeiris Louvaris^{1

2}

Affiliations

¹ Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium.
² Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.
³ Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.

Abstract

Background: Critically ill patients who have difficulties weaning from the mechanical ventilator are prone to develop respiratory muscle weakness. Inspiratory muscle training (IMT) can improve respiratory muscle strength. Whether IMT can improve scalene and sternocleidomastoid muscle oxygenation parameters is unknown.

Aim: To compare changes in muscle oxygenation parameters of scalene and sternocleidomastoid inspiratory muscles during a standardized task between patients with weaning difficulties who received either high-intensity IMT (intervention) or sham low-intensity IMT (control).

Method: Forty-one patients performed daily IMT sessions (4 sets, 6-10 breaths) until weaning success or for 28 consecutive days. The training load was progressively adjusted in the intervention group (n = 22) to the highest tolerable load, whilst the control group (n = 19) kept training at 10% of their baseline maximal inspiratory pressure (PImax). Breathing characteristics (i.e., work and power of breathing, PoB), respiratory muscle function [i.e., PImax and forced vital capacity (FVC)] were measured during a standardized loaded breathing task against a load of 30% of baseline PImax before and after the IMT period. In addition, during the same loaded breathing task, absolute mean and nadir changes from baseline in local scalene and sternocleidomastoid muscle oxygen saturation index (Δ%StiO₂) (an index of oxygen extraction) and nadir Δ%StiO₂ normalized for the PoB were measured by near-infrared spectroscopy.

Results: At post measures, only the intervention group improved mean PoB compared to pre measures (Pre: 0.42 ± 0.33 watts, Post: 0.63 ± 0.51watts, p-value < 0.01). At post measures, both groups significantly improved nadir scalene muscles StiO₂% normalized for the mean PoB (ΔStiO _nadir %/watt) compared to pre measurements and the improvement was not significant different between groups (p-value = 0.40). However, at post measures, nadir sternocleidomastoid muscle StiO₂% normalized for the mean PoB (ΔStiO _nadir %/watt) was significantly greater improved in the intervention group (mean difference: +18.4, 95%CI: -1.4; 38.1) compared to the control group (mean difference: +3.7, 95%CI: -18.7; 26.0, between group p-value < 0.01). Both groups significantly improved PImax (Intervention: +15 ± 13 cmH₂O p-value < 0.01, Control: +13 ± 15 cmH₂O p-value < 0.01). FVC only significantly improved in the intervention group (+0.33 ± 0.31 L p < 0.01) report also change in control group.

Conclusion: This exploratory study suggests that high-intensity IMT induces greater improvements in scalene and sternocleidomastoid muscle oxygenation parameters attributed for oxygen delivery, utilization and oxygen saturation index compared to low-intensity IMT in patients with weaning difficulties.

Keywords: cell respiration; intensive care unit; metabolism; near-infrared spectroscopy; respiratory muscle training; respiratory muscles; ventilator weaning.