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Updated: Aug 15, 2026

Inspiratory Muscle Training as an Adjunct to the Treatment of Weaning Failure in Critically Ill Patients: A Practical Guide
Published on: January 30, 2026
Manual hyperinflation improves alveolar recruitment in difficult-to-wean patients
Suh-Hwa Maa1, Tzong-Jen Hung, Kuang-Hung Hsu
1School of Nursing, Chang Gung University, 259, Wen-Hwa First Rd, Kwei-San, Tao-Yuan, Taiwan, ROC. shmaa@mail.cgu.edu.tw
Study Objectives:
To investigate the effect of manual hyperinflation (MH) in patients with atelectasis associated with ventilation support.
Design:
Patients were randomized to either an experimental group or a control group.
Setting:
Pulmonary ICUs from two hospitals.
Patients:
Twenty-three patients with atelectasis associated with ventilation support.
Interventions:
The MH technique was at a rate of 8 to 13 breaths/min for a period of 20 min each session, three times per day for 5 days. The control group received their standard prescribed mechanical ventilation without supplemental MH. Sputum contents (wet/dry weight ratio, viscosity), respiratory system capacity (spontaneous tidal volume [Vt], maximal inspiratory pressure, rapid shallow breathing index [f/Vt], chest radiograph signs, and Pa(O2)/fraction of inspired oxygen [Fi(O2)]) were measured just prior to the MH at day 0 as baseline, and at day 3 and day 6 of the study.
Measurements And Results:
There were significant improvements in scores over the 6-day study in the experimental group compared to the control group in spontaneous Vt (p = 0.035) and chest radiograph signs (p = 0.040), and a trend toward improvement of f/Vt (p = 0.066) and Pa(O2)/Fi(O2) (p = 0.061) after adjustment for covariates. Other outcome variables did not differ significantly between the experimental and control groups.
Conclusions:
MH performed on patients with atelectasis from ventilation support significantly improved alveolar recruitment.
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