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(Chest. 2005;128:2511-2520.)
© 2005 American College of Chest Physicians

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 and Nicolino Ambrosino, MD, FCCP

* 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{at}fsm.it

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 ({chi}2 = 0.004) and ET improvers ({chi}2 = 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.

Key Words: exercise therapy • rehabilitation • respiratory insufficiency • respiratory intermediate ICUs • weaning






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