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Clinical Investigations: CARDIOLOGY |

Supported Arm Training in Patients Recently Weaned From Mechanical Ventilation*

Roberto Porta, MD; Michele Vitacca, MD; Lucia Sonia Gilè, MD; Enrico Clini, MD, FCCP; Luca Bianchi, MD; Ercole Zanotti, MD; Nicolino Ambrosino, MD, FCCP
Author and Funding Information

*From the Pulmonary Divisions, Scientific Institutes of Gussago (Drs. Porta, Vitacca, Gilè, and Bianchi) and Montescano (Dr. Zanotti), Salvatore Maugeri Foundation IRCCS; Lung Function Unit (Dr. Clini), Hospital Foundation Villa Pineta and University Modena-Reggio Emilia, Pavullo; and Pulmonary Unit (Dr. Ambrosino), Cardio-Thoracic Department, University Hospital, Pisa, Italy.

Correspondence to: Michele Vitacca, MD, Fondazione S. Maugeri, Lung Function Unit, Istituto Scientifico di Gussago, I-25064 Gussago (BS), Italy; e-mail mvitacca@fsm.it



Chest. 2005;128(4):2511-2520. doi:10.1378/chest.128.4.2511
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Study objectives: To evaluate the effects of early exercise training in patients recovering from acute respiratory failure needing mechanical ventilation (MV).

Design: Prospective, randomized, and controlled study.

Setting: Three respiratory intermediate ICUs (RIICUs).

Patients: Of 228 patients admitted to an RIICU, 66 patients weaned from MV from > 48 to < 96 h were considered eligible and enrolled in the study.

Intervention: Sixty-six patients were randomized to either supported arm exercise training plus general physiotherapy (gPT) [group 1, 32 patients] or to gPT alone (group 2, 34 patients).

Measurements and results: Twenty-five patients in each group completed the protocol. Group 1 showed a greater improvement in exercise capacity, as assessed by an arm incremental test (IT) [p = 0.003] and an endurance test (ET) [p = 0.021], compared to group 2. Posttraining maximal inspiratory pressure (MIP) significantly improved in both groups (p < 0.001 and p = 0.003 in groups 1 and 2 respectively; not significant). IT isoworkload dyspnea improved significantly in both groups (p = 0.005 and p = 0.009 in groups 1 and 2, respectively; not significant between groups), whereas IT isoworkload peripheral muscle fatigue (p < 0.001), ET isotime dyspnea (p < 0.01), and ET isotime muscular fatigue (p < 0.005) improved significantly in group 1 but not in group 2. IT improvers (χ2 = 0.004) and ET improvers (χ2 = 0.047) were more frequently observed in group 1 than in group 2. Baseline MIP could discriminate for IT (p = 0.013; odds ratio [OR], 1.116) and ET improvers (p = 0.022; OR, 1.067).

Conclusion: Early upper-limb exercise training is feasible in RIICU patients recently weaned from MV and can enhance the effects of gPT. Baseline inspiratory muscle function is related to exercise capacity improvement.

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