Inspiratory muscle training in a newborn with anoxia who was chronically ventilated

Marisa Afonso Andrade Brunherotti, Poliana Penasso Bezerra, Cynthia Kallas Bachur, Carlos Reis Jacometti
Physical Therapy 2012, 92 (6): 865-71

BACKGROUND AND PURPOSE: Respiratory muscle training promotes weaning in patients who are dependent on mechanical ventilation. Respiratory muscles can be trained using linear inspiratory-resistive loads to improve their strength and endurance. The purpose of this case report is to demonstrate that a therapeutic intervention consisting of a linear pressure load device facilitates ventilator weaning in an infant who is chronically ventilated.

CASE DESCRIPTION: The patient was a newborn with a weight of 4,725 g and an Apgar score of 0 to 1 who had been on mechanical ventilation for 8 months. Respiratory muscle training with a linear pressure load was performed twice a day. The number of series and repetitions was increased progressively while maintaining the pressure load, with 3-minute intervals between series, until reaching a peak of 8 series with 70 repetitions and a pressure load of 13 cm H(2)O. During the intervention, the patient was maintained in the supine position at an elevation of 30 degrees.

OUTCOMES: The infant required mechanical ventilation for 8 months (32 weeks of life), with 4,450 hours (26.5 weeks) of mechanical ventilation and 230 cumulative hours (1.4 weeks) of spontaneous breathing, without obtaining any weaning success. At 10 months of age (40 weeks) and after 2 months (8 weeks) of respiratory muscle training, the results were 490 hours (3 weeks) of mechanical ventilation and 854 hours (5 weeks) of spontaneous breathing. Complete independence of the infant from mechanical ventilation was achieved thereafter.

DISCUSSION: This case report describes respiratory muscle training using a linear pressure load device to successfully wean an infant from mechanical ventilation. However, well-controlled clinical trials are necessary to better understand the effects of this intervention on neonatal respiratory muscles.

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