Related Experiment Video
Updated: Mar 10, 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
Activation of respiratory muscles during weaning from mechanical ventilation
Stephan Walterspacher1, Julia Gückler2, Fabian Pietsch2
1Department of Pneumology, Cardiology and Intensive Care Medicine, Klinikum Konstanz, Luisenstr. 7, 78464 Konstanz, Germany; Department of Pneumology and Internal Medicine, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
Purpose:
Respiratory muscle dysfunction is a key component of weaning failure. Balancing respiratory muscle loading and unloading by applying different ventilation modes along with spontaneous breathing episodes are established weaning strategies. However, the effects of body positioning on the respiratory muscles during weaning remains unclear.
Materials And Methods:
This study aimed at assessing respiratory drive by surface electromyography (EMG) of the diaphragm (EMGdia) and parasternal muscles (EMGpara) in tracheotomized patients during prolonged weaning in 3 randomized body positions-supine, 30° semirecumbent, and 80° sitting-during mechanical ventilation and spontaneous breathing.
Results:
Nine patients were included for analysis. Cardiorespiratory parameters (heart rate, blood pressure, arterial oxygen saturation, dyspnea) did not change under each condition (all P>.05). EMGpara and EMGdia did not change under mechanical ventilation (both P>.05). EMGdia changed under spontaneous breathing from supine to sitting (0.45±0.26 vs 0.32±0.19; P=.012) and between semirecumbent to sitting (0.41±0.23 vs 0.32±0.19; P=.039), whereas EMGpara did not change.
Conclusions:
This is the first study to show that body positioning influences respiratory drive to the diaphragm in tracheotomized patients with prolonged weaning from mechanical ventilation during unassisted breathing. Sitting position reduces respiratory drive compared with semirecumbent and supine positioning and might therefore be favored during spontaneous breathing trials.
Related Concept Videos
01:21Mechanism of Breathing III: The Accessory Muscles
The respiratory system is a complex network that relies on primary respiratory muscles like the diaphragm, but also involves accessory muscles to enhance lung expansion and airflow during both inhalation and exhalation.
Enhancing Inhalation with Accessory Muscles:
Accessory muscles such as the sternocleidomastoid, scalene, intercostal, and abdominal muscles are crucial when additional respiratory effort is required, such as during deep...
01:30Mechanism of Breathing I: Inspiration
The respiratory system, an essential network for breathing, comprises the conducting and respiratory zones, each playing a crucial role in the overall process of respiration. Let us explore the detailed mechanism of inspiration, or inhalation, which is the first phase of the respiratory cycle.
Pathway of Air during Inspiration
During inspiration, air enters our body through the nose or mouth and moves through the conducting zone,...
01:29Mechanical Ventilation I: Indication and Settings
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:23Mechanism of Breathing II: Expiration
Expiration, or exhaling, is a complex physiological process that begins as the inspiratory muscles begin to relax. This relaxation triggers a series of events that epitomize the efficiency of the respiratory system.
Mechanism of Expiration: