Inspiratory Strength Training in Pediatric Cardiac Critical Care: A Retrospective Cohort Study
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Background
Prolonged mechanical ventilation (MV) is associated with inspiratory muscle weakness and difficulty weaning from respiratory support. While inspiratory strength training (IST) has demonstrated efficacy in adult critical care populations, the data in pediatric cardiac critical care remains limited. We sought to evaluate the feasibility, safety, and physiologic response to IST in children in the pediatric cardiac intensive care unit (PCICU).
Methods and Results
We performed a single-center retrospective cohort study of children with congenital heart disease referred for IST between January 2015 and August 2021. Feasibility was defined as completion of ≥1 IST session following referral. Safety outcomes included physiologic events documented during IST sessions. Changes in maximal inspiratory pressure (MIP) were assessed in patients who completed ≥2 IST sessions. Of 105 eligible patients, 93 (89%) successfully completed at least 1 IST session. Across 389 IST sessions, monitoring events included pre-oxygenation (62%), desaturations (13%), bradycardia (7%), and hypertension (2%). All events were transient and did not require escalation of care. 84% of patients were successfully liberated from MV after a median of 2 (IQR 1-4) IST sessions. Among patients completing ≥2 sessions, MIP improved significantly over time (p < 0.0001). Improvements were observed in both patients who did and did not wean from MV. Patients who failed to wean had longer ventilator exposure prior to IST initiation and greater sedation at baseline.
Conclusions
IST was feasible and well tolerated in this medically complex PCICU cohort. High completion rates and improvements in MIP support IST as a clinically deliverable intervention that can improve inspiratory muscle strength during critical illness.
