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Effects of threshold inspiratory muscle trainer versus trigger sensitivity adjustment versus conventional therapy on

Heba A A Abdeen¹, Hady Atef², Nesreen G Elnahas¹

¹Department of Physical Therapy for Cardiovascular/ Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Egypt.

Respiratory Physiology & Neurobiology

|July 4, 2025

Abstract

Background:

Prolonged mechanical ventilation in chronic obstructive pulmonary disease is associated with severe complications, and then earlier weaning is desirable. Then, strategies such as inspiratory muscle training (IMT) have been studied. This study aimed to compare the effects of IMT via Threshold device versus trigger sensitivity adjustment of the mechanical ventilator versus conventional therapy on respiratory parameters on chronic obstructive pulmonary disease weaning patients.

Methods:

Ninety patients (aged 50-70) with acute respiratory failure on mechanical ventilation selected from the Intensive Care Unit were randomly assigned into: IMT via Threshold and conventional physical therapy group; trigger sensitivity adjustment of the mechanical ventilator and conventional physical therapy group; and conventional physical therapy alone group. Negative inspiratory force (NIF), respiratory rate (RR), tidal volume (VT), rapid shallow breathing index (RSBI), pH, and oxygenation parameters (PaO₂, PaCO_2, and P/F ratio) were measured pre and post-treatment.

Results:

Threshold group showed higher improvements in NIF than the trigger sensitivity adjustment group (p = 0.002; ES: 0.91). Threshold group showed better results in all measures than conventional physical therapy group except for pH and PaCO₂. Trigger sensitivity adjustment and conventional physical therapy groups showed significant improvements in all measurements (p < 0.005 for NIF (2.30), RR (1.69), VT (0.80); RSBI (2.09), PaO₂ (1.20), P/F ratio (1.22) except for VT, pH, and PaCO₂ with preference to trigger sensitivity adjustment group. No significant differences were found in the percentage of weaning between groups, but Threshold group showed significantly lower weaning days than conventional physical therapy group (p = 0.004, ES:1.01).

Conclusion:

The respiratory training with the IMT device has significantly higher improvements than the other techniques and reduces the weaning duration.

Keywords:

Chronic obstructive pulmonary disease Diaphragm Inspiratory muscle training Intensive care unit Mechanical ventilation Respiratory failure Threshold IMT device

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