Respiratory Muscle Training in the ICU: IMT vs Diaphragmatic NMES
2 de mayo de 2026 actualizado por: Ali Yalman
Comparing the Effects of Inspiratory Muscle Training and Diaphragmatic Neuromuscular Electrical Stimulation in Mechanically Ventilated Patients: A Randomized Controlled Trial
This study aimed to compare the effects of Inspiratory Muscle Training (IMT) and Diaphragmatic Neuromuscular Electrical Stimulation (NMES) on inspiratory muscle strength, mechanical ventilator parameters, and functional levels in intubated intensive care unit (ICU) patients.
Thirty-two intubated patients were divided into two groups: the IMT group and the NMES group.
In the IMT group, IMT was administered twice a day in addition to routine physiotherapy.
In the NMES group, electrical stimulation was applied to the diaphragm muscle for 40 minutes in addition to routine physiotherapy.
The primary outcomes of the study are inspiratory muscle strength and physical function level.
The secondary outcomes are mechanical ventilator parameters, extubation time, and length of hospital stay.
Descripción general del estudio
Estado
Terminado
Condiciones
Descripción detallada
This randomized study aimed to compare the effects of Inspiratory Muscle Training (IMT) and Neuromuscular Electrical Stimulation (NMES) on inspiratory muscle strength, mechanical ventilator parameters, and functional levels in intensive care unit (ICU) patients.
A total of 32 mechanically ventilated patients were randomly assigned to either an IMT group (n=16) or an NMES group (n=16). In addition to routine ICU physiotherapy, the IMT group received inspiratory muscle training using Philips Respironics Threshold IMT devices, while the NMES group received stimulation on the diaphragm with Aussie current using surface electrodes.
Tipo de estudio
Intervencionista
Inscripción (Actual)
32
Fase
- No aplica
Contactos y Ubicaciones
Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.
Ubicaciones de estudio
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Hatay, Turquía (Türkiye), 31060
- Hatay Mustafa Kemal University
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Criterios de participación
Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
- Adulto Mayor
Acepta Voluntarios Saludables
No
Descripción
Inclusion Criteria
- Being intubated
- Conscious state
- Ability to trigger mechanical ventilation
- Capability to execute at least one motor command
Exclusion Criteria
- Any neurological or orthopedic diagnosis or deficits
- Inability to cooperate with the physiotherapist
- Hemodynamic instability despite medical treatment
- Excessive secretions requiring aspiration more than once per hour.
Plan de estudios
Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Doble
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
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Comparador activo: Inspiratory Muscle Training (IMT)
As a result of randomization, the IMT group consisted of 16 participants with a mean age of 70 ± 9.57 years.
IMT was administered to the participants twice a day following routine physiotherapy, which included breathing exercises and mobilization.
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Routine ICU physiotherapy includes: conventional chest physiotherapy, consisting of diaphragmatic breathing, thoracic expansion exercises, postural drainage, cough training, and in-bed ROM exercises and mobilization.
In addition to routine ICU physiotherapy, patients received IMT twice daily with Threshold IMT devices (Respironics, New Jersey, Inc., NJ, USA).
The IMT program started at 30% of pretreatment Pimax and was increased by 2H2O daily according to patients' tolerance.
A total of 3 sets of 8 repetitions were applied.
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Experimental: Neuromuscular electric stimulation (NMES)
As a result of randomization, the NMES group consisted of 16 participants with a mean age of 65.31 ± 8.38 years.
Following routine intensive care physiotherapy, which included breathing exercises and mobilization, NMES was applied to the diaphragm muscle for 40 minutes.
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Routine ICU physiotherapy includes: conventional chest physiotherapy, consisting of diaphragmatic breathing, thoracic expansion exercises, postural drainage, cough training, and in-bed ROM exercises and mobilization.
In addition to routine ICU physiotherapy, patients received NMES on the diaphragm with surface electrodes.
Electrodes were placed at four channels with two electrodes on both sides of the xiphoid at the level of the intercostal space of the 7th and 8th ribs, superiorly and inferiorly.
In addition, two electrodes with two channels were placed superiorly and inferiorly at the midaxillary level of the intercostal space of the 7th and 8th ribs.
A total of 4 channels and 8 electrodes were used with modified burst series biphasic current 30 Hz (Aussie current).
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
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Inspiratory muscle strength
Periodo de tiempo: Baseline, 1 hour before extubation, 1 hour before discharge
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Inspiratory muscle strength (Pimax) was assessed by a desktop spirometer with Pimax module (Pony Fx, COSMED, Rome, Italy).
A catheter mount piece was placed in front of the pressure measurement part of spirometer to perform the measurement in intubated participants.
Participants were encouraged throughout the measurements to achieve maximum strength and coordination.
The measurements were repeated three times, and the average of these values was recorded.
To prevent respiratory muscle fatigue, at least a one-minute break was provided between trials.
Results were reported in cmH2O units.
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Baseline, 1 hour before extubation, 1 hour before discharge
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Physical Functions
Periodo de tiempo: Baseline, 1 hour before discharge
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Physical function levels of patients were evaluated by Physical Function Intensive Care Unit Test-scored (PFIT-s).
Physical Function Intensive Care Unit Test-scored has 4 test components; shoulder flexion strength, knee extension strength, sit to stand assistance, step cadence.
Before the test, the participant was expected to correctly answer 2 of 5 questions to assessing the cooperation.
Participants' vital signs were noted before and after the test.
Participants are scored on a total scale ranging from 0 to 10.
A score of 0 signifies total dependence and poor muscle strength, whereas a score of 10 represents functional independence and optimal muscle strength.
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Baseline, 1 hour before discharge
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
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Mechanical Ventilatory Parameters - Tidal Volumes
Periodo de tiempo: Baseline, 1 hour before extubation
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Respitatory parameters were assessed by mechanic ventilator (The Engstrom Carestation, GE Health Care 2016).
The test procedure; device was switched to CPAP mode, Psupport was set to 10 cmH2O and PEEP was set to 5 cmH2O to overcome the physiological resistance of the ventilator circuit.
The patient was instructed to take deep breaths for one minute.
As the measurements required patient motivation and coordination, the tests were conducted by providing appropriate verbal commands.
Inspiratory tidal volume (TVi) and expiratory tidal volume (TVe) were recorded in milliliters (ml).
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Baseline, 1 hour before extubation
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Mechanical Ventilatory Parameter - Minute Ventilation
Periodo de tiempo: Baseline, 1 hour before extubation
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Respitatory parameters were assessed by mechanic ventilator (The Engstrom Carestation, GE Health Care 2016).
The test procedure; device was switched to CPAP mode, Psupport was set to 10 cmH2O and PEEP was set to 5 cmH2O to overcome the physiological resistance of the ventilator circuit.The patient was instructed to perform deep breathing for a period of one minute.
Since the measurement required patient motivation and coordination, the tests were conducted by providing appropriate verbal commands.
Minute ventilation was recorded in liters per minute (L/min)
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Baseline, 1 hour before extubation
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Length of time intubated
Periodo de tiempo: 12 hours after extubation
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The duration of intubation for the participants was reported in days.
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12 hours after extubation
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Hospital stay length
Periodo de tiempo: 2 hours after discharge
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The duration of hospital stay was reported in days
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2 hours after discharge
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Colaboradores e Investigadores
Aquí es donde encontrará personas y organizaciones involucradas en este estudio.
Patrocinador
Publicaciones y enlaces útiles
La persona responsable de ingresar información sobre el estudio proporciona voluntariamente estas publicaciones. Estos pueden ser sobre cualquier cosa relacionada con el estudio.
Publicaciones Generales
- Denehy L, de Morton NA, Skinner EH, Edbrooke L, Haines K, Warrillow S, Berney S. A physical function test for use in the intensive care unit: validity, responsiveness, and predictive utility of the physical function ICU test (scored). Phys Ther. 2013 Dec;93(12):1636-45. doi: 10.2522/ptj.20120310. Epub 2013 Jul 25.
- Leite MA, Osaku EF, Albert J, Costa CRLM, Garcia AM, Czapiesvski FDN, Ogasawara SM, Bertolini GRF, Jorge AC, Duarte PAD. Effects of Neuromuscular Electrical Stimulation of the Quadriceps and Diaphragm in Critically Ill Patients: A Pilot Study. Crit Care Res Pract. 2018 Jul 8;2018:4298583. doi: 10.1155/2018/4298583. eCollection 2018.
- Dos Santos FV, Cipriano G Jr, Vieira L, Guntzel Chiappa AM, Cipriano GBF, Vieira P, Zago JG, Castilhos M, da Silva ML, Chiappa GR. Neuromuscular electrical stimulation combined with exercise decreases duration of mechanical ventilation in ICU patients: A randomized controlled trial. Physiother Theory Pract. 2020 May;36(5):580-588. doi: 10.1080/09593985.2018.1490363. Epub 2018 Oct 15.
Fechas de registro del estudio
Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.
Fechas importantes del estudio
Inicio del estudio (Actual)
5 de marzo de 2020
Finalización primaria (Actual)
20 de octubre de 2021
Finalización del estudio (Actual)
23 de noviembre de 2021
Fechas de registro del estudio
Enviado por primera vez
11 de abril de 2026
Primero enviado que cumplió con los criterios de control de calidad
2 de mayo de 2026
Publicado por primera vez (Actual)
6 de mayo de 2026
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
6 de mayo de 2026
Última actualización enviada que cumplió con los criterios de control de calidad
2 de mayo de 2026
Última verificación
1 de mayo de 2026
Más información
Términos relacionados con este estudio
Palabras clave
Otros números de identificación del estudio
- 60116787-020/46004
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
NO
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
No
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
No
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