What question did this study set out to answer?

To evaluate the efficacy of inspiratory muscle training on weaning success, maximal inspiratory pressure, and rapid shallow breathing index in mechanically ventilated ICU patients.

March 29, 2026Open Access

Efficacy of inspiratory muscle training on weaning success in mechanically ventilated ICU patients: a systematic review and network meta-analysis of randomized controlled trials

EMErika Meléndez-OlivaUniversity of Alicante JCJuan Nicolas Cuenca-ZaldivarFoundation for Biomedical Research NCNina Cadeau ComteNIHR Oxford Musculoskeletal Biomedical Research Centre

Key Points

To evaluate the efficacy of inspiratory muscle training on weaning success, maximal inspiratory pressure, and rapid shallow breathing index in mechanically ventilated ICU patients.
Systematic review of randomized controlled trials
Included studies from PubMed, Cochrane Library, and PEDro until July 2025
Primary outcome measure was successful weaning
Secondary outcomes were maximal inspiratory pressure and rapid shallow breathing index
Risk of bias assessed using RoB 2.0 and frequentist network meta-analysis conducted
High-intensity inspiratory muscle training significantly improved maximal inspiratory pressure compared to controls
No significant differences were observed for rapid shallow breathing index among active interventions
High-intensity IMT demonstrated a higher probability of successful weaning than control (odds ratio 0.32, 95% CI 0.14–0.75)
Substantial heterogeneity was noted for continuous outcomes, while negligible for weaning success

Abstract

Inspiratory muscle training (IMT) has been proposed as a strategy to mitigate ventilator-induced diaphragmatic dysfunction in mechanically ventilated intensive care unit (ICU) patients. However, its comparative effectiveness across different training intensities and impact on weaning success remain uncertain. To evaluate the efficacy of intima-media thickness (IMT) on weaning success, maximal inspiratory pressure (MIP), and rapid shallow breathing index (RSBI) in mechanically ventilated adult intensive care unit (ICU) patients. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251026681). PubMed, Cochrane Library, and PEDro were searched through July 2025 for randomized controlled trials (RCTs) including ICU adults receiving invasive mechanical ventilation for ≥ 48 h. The primary outcome measure was successful weaning. The secondary outcomes were MIP and RSBI. The Risk of bias was assessed using RoB 2.0. A frequentist network meta-analysis was conducted using standardized mean differences (SMD) and odds ratios (OR). Eighteen RCTs (n = 1137) were included. Network meta-analysis demonstrated that high-intensity IMT (HI-IMT) and HI-IMT combined with proprioceptive neuromuscular facilitation showed significant improvements in MIP compared to controls. No significant differences were observed between the active interventions for RSBI. For weaning success, the HI-IMT group showed a higher probability of successful weaning than the control group (odds ratio OR 0.32, 95% CI 0.14–0.75). Heterogeneity was substantial for continuous outcomes (I² >85%) and negligible for weaning success (I²=0%). IMT improves inspiratory muscle strength in mechanically ventilated ICU patients, particularly when delivered at higher intensities. Although high-intensity IMT was associated with improved weaning success in the network analysis, the overall clinical impact should be interpreted cautiously, given the heterogeneity and indirect nature of some comparisons. Further adequately powered trials with standardized protocols are warranted.

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