Overview
Restrictive lung diseases (RLD) represent a significant cause of morbidity, often necessitating intensive interventions such as mechanical ventilation due to diminished lung compliance (LC) and reduced total lung capacity (TLC). Mechanical ventilation, while vital, is associated with ventilator-induced diaphragmatic dysfunction (VIDD), leading to rapid muscle atrophy and impeding patient recovery.
This proposed study aims to evaluate the clinical impact of IMT and PEP on improving respiratory muscle strength, lung compliance and mobilizing secretions (effective cough reflex) in patients with RLD who require mechanical ventilation.
Description
Restrictive lung diseases (RLD) (including interstitial lung diseases, idiopathic lung fibrosis, chest wall deformities, and neuromuscular diseases) represent a significant cause of morbidity, often necessitating intensive interventions such as mechanical ventilation due to diminished lung compliance (LC) and reduced total lung capacity (TLC).
Mechanical ventilation, while vital, is associated with ventilator-induced diaphragmatic dysfunction (VIDD), leading to rapid muscle atrophy and impeding patient recovery.
Earlier research has highlighted the potential of targeted respiratory interventions, including inspiratory muscle training (IMT) and positive expiratory pressure (PEP), to mitigate these effects; however, evidence in mechanically ventilated RLD populations remains limited.
This proposed study aims to evaluate the clinical impact of IMT and PEP on improving respiratory muscle strength, lung compliance and mobilizing secretions (effective cough reflex) in patients with RLD who require mechanical ventilation.
The project will use a randomized controlled design, collecting both physiological and clinical outcome data, and will follow ethical guidelines for human research.
This project addresses an important clinical problem with substantial gaps in the literature regarding combined inspiratory and expiratory muscle training in ventilated patients and proposes an applied solution poised to advance respiratory care practices in Pakistan, with positive repercussions for patient outcomes, healthcare sustainability, and the national economy.
Eligibility
Inclusion Criteria:
- Patients aged between 18 and 60 years.
- Diagnosed with restrictive lung disease (RLD), including interstitial lung diseases, idiopathic pulmonary fibrosis, chest wall deformities, or neuromuscular diseases.
- Admitted to the ICU and requiring invasive mechanical ventilation for more than 48 hours.
- Glasgow Coma Scale score over 13, inspiratory pressures below -20 cmH2O, oxygen saturation above 90%, tidal volumes exceeding 5ml/kg, respiratory rates under 35 breaths per minute
- Hemodynamically stable at the time of enrolment (as determined by the treating physician).
Exclusion Criteria:
- Pre-existing chronic obstructive pulmonary disease (COPD) or other primary obstructive pathologies.
- Hemodynamic instability (e.g., requiring high-dose vasopressors).
- Active pneumothorax or untreated bronchopleural fistula.
- History of cranial or facial trauma, recent thoracic or abdominal surgery contraindicating the intervention.
- Pre-existing cognitive impairment or inability to comprehend and cooperate with the training protocol.
