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Inspiratory Muscle Strength Training in Infants With Congenital Heart Disease and Prolonged Mechanical Ventilation: A Case Report

Barbara K. Smith, Mark S. Bleiweis, Cimaron R. Neel, A. Daniel Martin
DOI: 10.2522/ptj.20110348 Published 1 February 2013
Barbara K. Smith
B.K. Smith, PT, PhD, Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610-0154 (USA).
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Mark S. Bleiweis
M.S. Bleiweis, MD, Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida.
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Cimaron R. Neel
C.R. Neel, PA, Department of Pediatrics, University of Florida.
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A. Daniel Martin
A.D. Martin, PT, PhD, Department of Physical Therapy, University of Florida.
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Figures

Figure 1.
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Figure 1.

Devices used to evaluate and train inspiratory muscle strength: (A) A unidirectional valve and respiratory monitor adapter was attached directly to the end of the endotracheal tube to measure maximal inspiratory pressure. This device also was used to provide inspiratory muscle strength training to infant 1. (B) An inverted positive end-expiratory pressure valve was used to provide a fixed pressure-threshold inspiratory load for infant 2's inspiratory muscle strength training.

Figure 2.
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Figure 2.

Example of the pressure-time waveform generated during a 15-second inspiratory occlusion maneuver to evaluate maximal inspiratory pressure (MIP) in infant 2. The most negative pressure was the MIP, and rate of inspiratory pressure development was calculated from the time to generate MIP (red arrows).

Figure 3.
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Figure 3.

Inspiratory muscle performance of the infants: (A) maximal inspiratory pressure and (B) rate of inspiratory pressure development increased in both infants at the time of extubation. The “Pre” measurements reflect the infants' status at rest, prior to the initial evaluation. The “Post” measurements were taken at rest, prior to the last session of inspiratory muscle strength training and extubation.

Tables

Table.
Table.

Resting Breathing Pattern and Respiratory Mechanicsa

  • ↵a Resting breathing pattern and mechanics were measured with the infant in a calm, awake state every morning with a respiratory monitor (Philips-Respironics CO2SMO). After inspiratory muscle strength training, infants used a slower, deeper breathing pattern with reduced airway resistance in preparation for ventilator weaning. The “Pre” measurements reflect the infants' status at rest, prior to the initial evaluation. The “Post” measurements were taken at rest, prior to the last session of inspiratory muscle strength training and extubation. IMV=intermittent mandatory ventilation; Cdyn=dynamic compliance, Rawi=dynamic inspiratory airway resistance; Rawe=dynamic expiratory airway resistance; PaO2/FiO2=partial pressure of oxygen, arterial/fraction of inspired oxygen, N/A=not applicable.

Supplementary Data

eTables

Files in this Data Supplement:

  • eTables (PDF) (33 KB) - This PDF contains the following eTables:
    • eTable 1. Summary of Hospital Course for Infant 1
    • eTable 2. Summary of Hospital Course for Infant 2
    • eTable 3. Vital Signs Associated With Training Sessions for Infant 1
    • eTable 4. Vital Signs Associated With Training Sessions for Infant 2
    • eTable 5. Echocardiogram of Infant 1 on Initial Evaluation
    • eTable 6. Echocardiogram of Infant 2
    • eTable 7. Detailed Ventilator Settings and Pulmonary Mechanics During the Course of Treatment for Infant 1
    • eTable 8. Detailed Ventilator Settings and Pulmonary Mechanics During the Course of Treatment for Infant 2
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Vol 93 Issue 2 Table of Contents
Physical Therapy: 93 (2)

Issue highlights

  • Physical Therapists' Management of Patients With Post–Intensive Care Syndrome
  • An Early Mobilization Protocol in a Trauma and Burns Intensive Care Unit
  • An Early Mobility Protocol to Increase Ambulation in Intensive and Intermediate Care Settings
  • An Early Mobilization Program for Patients With Aneurysmal Subarachnoid Hemorrhage
  • Physical Therapist Student Confidence and Simulation-Based Management of Patients in Critical Care
  • Inspiratory Muscle Training in Infants
  • Mobility Strategies for the Patient With Intensive Care Unit–Acquired Weakness
  • Rehabilitation in Patients Receiving ECMO
  • Delivery of Physical Therapy Services for Individuals With Critical Illness
  • Physical Therapist Management of Patients With Ventricular Assist Devices
  • Exercise, Weight Loss, and Hip Osteoarthritis
  • A Novel, Intensive, Task-Specific Intervention for Individuals With Chronic Stroke
  • Psychometric Properties of the Mini-BESTest and BBS in Patients With Balance Disorders
  • Biofeedback System for Sensory Evaluation and Re-education
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Inspiratory Muscle Strength Training in Infants With Congenital Heart Disease and Prolonged Mechanical Ventilation: A Case Report
Barbara K. Smith, Mark S. Bleiweis, Cimaron R. Neel, A. Daniel Martin
Physical Therapy Feb 2013, 93 (2) 229-236; DOI: 10.2522/ptj.20110348

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Inspiratory Muscle Strength Training in Infants With Congenital Heart Disease and Prolonged Mechanical Ventilation: A Case Report
Barbara K. Smith, Mark S. Bleiweis, Cimaron R. Neel, A. Daniel Martin
Physical Therapy Feb 2013, 93 (2) 229-236; DOI: 10.2522/ptj.20110348
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    • Abstract
    • Patient History and Systems Review: Case 1
    • Patient History and Systems Review: Case 2
    • Examination
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  • Case Reports
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