# Savonia Article Pro: Inspiratory Muscle Training in Weaning Intensive Care Patients from Mechanical Ventilation

##### Savonia Article Pro is a collection of multidisciplinary Savonia expertise on various topics.

22.10.2026 [Articles Pro](https://www.savonia.fi/en/category/articles-pro)[Sosiaali- ja terveysala](https://www.savonia.fi/en/category/sosiaali-ja-terveysala)

## Introduction

Prolonged mechanical ventilation is one of the major challenges in intensive care. Although mechanical ventilation is often a life-saving intervention, prolonged ventilatory support can contribute to respiratory muscle weakness, particularly dysfunction of the diaphragm. This may complicate weaning from mechanical ventilation and increase the risk of prolonged intensive care unit (ICU) stays and other complications. (Ha et al., 2024.)

In physiotherapy, inspiratory muscle training (IMT) provides a non-pharmacological and targeted form of rehabilitation aimed at strengthening the respiratory muscles and supporting the process of weaning from mechanical ventilation. A previous systematic review involving seven randomized controlled trials found that IMT improved inspiratory muscle strength, although its effects on successful weaning were less clear (Alonso-Pérez et al., 2025). Furthermore, clinical practice guidelines suggest that IMT may improve weaning success, but the certainty of evidence remains low (Ha et al., 2024). These findings highlight the importance of further investigating the effectiveness of IMT and identifying appropriate training protocols for critically ill patients.

This article was prepared within the Professional in Physiotherapy course included in the physiotherapy degree programme. The article represents students’ work completed as part of the evidence-based physiotherapy component of the course. During the course, students work collaboratively in small groups to practice the key stages of a systematic review process by conducting a mini review. This includes systematic literature searching, critical appraisal using the PEDro scale, data synthesis, and reporting the findings in the form of a scientific manuscript.

## Aim

The aim of the mini literature review was to describe and compare the effects of inspiratory muscle training on respiratory muscle strength and weaning from mechanical ventilation in adult intensive care patients.

## Methods

The literature search was conducted in healthcare databases (PubMed, CINAHL). The search keywords included “inspiratory muscle training”, “mechanical ventilation”, and “ICU”. Eligible studies were randomized controlled trials (RCTs) published in English in recent years that investigated inspiratory muscle training (IMT) in mechanically ventilated adult intensive care unit (ICU) patients. Studies assessing respiratory muscle strength and weaning outcomes were considered relevant.

The study selection process involved screening titles and abstracts, followed by reviewing the full texts of potentially relevant articles. Studies meeting the inclusion criteria were selected for the review. Three randomized controlled trials were included based on their relevance to the research question. Data was extracted from the selected studies regarding participant characteristics, interventions, comparison groups, and main findings. The studies were compared to identify similarities and differences in respiratory muscle strength, weaning outcomes, and training protocols. The quality of the studies was assessed using the PEDro scale (Physiotherapy Evidence Database), which is well established in physiotherapy and healthcare research (Cashin & McAuley, 2020).

## Results

The mini literature review included three randomized controlled trials involving a total of 195 mechanically ventilated intensive care patients. The studies were conducted in Taiwan (Wang et al., 2025), France (Réginault et al., 2024), and Iran (Kazemi et al., 2024). The methodological quality of the included studies was evaluated using the PEDro scale. The assessments identified methodological strengths and limitations, particularly regarding blinding and allocation of concealment. The study by Wang et al. (2025) received 8/10 points, Kazemi et al. (2024) received 7/10 points, and Réginault et al. (2024) received 6/10 points in our student group’s assessments.

## Effects on respiratory muscle strength

The findings of the mini literature review indicate that inspiratory muscle training may improve respiratory muscle strength in mechanically ventilated intensive care patients. Two of the three included studies demonstrated significant improvements in maximal inspiratory pressure (MIP) compared with usual care (Wang et al., 2025; Kazemi et al., 2024). However, the findings were not entirely consistent across the studies. Réginault et al. (2024) compared different training intensities and found no statistically significant differences between low-, high-, and mixed-intensity programs in the development of muscle strength or endurance among patients experiencing difficult weaning. Unlike the other two studies, this study focused on comparing different IMT protocols rather than comparing IMT with usual care. Therefore, its findings do not necessarily contradict the improvements observed in other studies. Wang et al. (2025) investigated 33 patients who had received mechanical ventilation for more than two days. The intervention group received IMT twice daily, five days per week, for three consecutive weeks. The study reported improvements in respiratory muscle strength and breathing parameters, including maximal inspiratory pressure (MIP). Kazemi et al. (2024) investigated 70 mechanically ventilated patients. The intervention combined standard chest physiotherapy with inspiratory and expiratory muscle training using a threshold IMT/PEP device twice daily for seven days. The intervention group demonstrated improvements in respiratory muscle strength and lung function compared with the control group.

## Effects on weaning from mechanical ventilation

Wang et al. (2025) found that patients in the training group were successfully weaned from mechanical ventilation an average of 5.5 days earlier than those in the control group (12.6 days vs. 18.1 days). Kazemi et al. (2024) reported a higher successful weaning rate in the intervention group compared with the control group (74.3% vs. 48.6%). Extubation success was also higher in the intervention group (68.6% vs. 40.0%). However, no statistically significant difference was found in the overall duration of mechanical ventilation. Together, these findings suggest that respiratory muscle training may improve weaning and extubation success. However, improvements in respiratory muscle strength do not necessarily result in a shorter duration of mechanical ventilation.

## Differences between training programs

The three studies differed in their patient populations, training protocols, and intervention durations. Wang et al. (2025) used IMT twice daily, five days per week, for three weeks, whereas Kazemi et al. (2024) combined inspiratory and expiratory muscle training twice daily for seven days. Réginault et al. (2024) compared three different IMT intensities. Training was performed twice daily, seven days per week, until successful extubation or for a maximum of 30 days. None of the training programs were found to be superior to the others in improving inspiratory muscle strength or endurance. A noticeable difference between the studies was that Kazemi et al. (2024) investigated a combined inspiratory and expiratory muscle training intervention, whereas the other studies focused on inspiratory muscle training. This should be considered when comparing the findings, as the effects of inspiratory muscle training alone cannot be determined from the combined intervention.

## Conclusions

Based on the findings of this mini literature review, inspiratory muscle training appears to be a promising physiotherapy intervention for improving respiratory muscle strength and supporting weaning from mechanical ventilation in intensive care patients. The findings were not entirely consistent regarding the duration of mechanical ventilation or the optimal training intensity. Differences in study designs, patient populations, and training protocols make direct comparisons challenging.

Larger randomized controlled trials using standardized training programs are needed to determine the optimal training intensity, frequency, and duration, as well as to evaluate long-term outcomes and safety in intensive care.

#### Authors

Veera Järvinen, Physiotherapy Student, Savonia University of Applied Sciences

Minttu Kurki, Physiotherapy Student, Savonia University of Applied Sciences

Miisa Savolainen, Physiotherapy Student, Savonia University of Applied Sciences

Marja Äijö PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences

This article was prepared with the help of AI.

#### References

Alonso-Pérez, J. L., Riquelme-Aguado, V., Rodríguez-Prieto, D., López-Mejías, A., Romero-Morales, C., Rossettini, G., & Villafañe, J. H. (2025). Inspiratory Muscle Training and Its Impact on Weaning Success in Mechanically Ventilated ICU Patients: A Systematic Review. Journal of functional morphology and kinesiology, 10(2), 111. [https://doi.org/10.3390/jfmk10020111](https://doi.org/10.3390/jfmk10020111). Referenced 16.10.2026.

Cashin, A. G., & McAuley, J. H. 2020. Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale. Journal of Physiotherapy, 66(1), 59. [https://doi.org/10.1016/j.jphys.2019.08.005](https://doi.org/10.1016/j.jphys.2019.08.005). Referenced 1.10.2026.

Ha, T. S., Oh, D. K., Lee, H. J., Chang, Y., Jeong, I. S., Sim, Y. S., Hong, S. K., Park, S., Suh, G. Y., Park, S. Y. (2024). Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines. Acute and Critical Care, 39(1), 1–23. [https://doi.org/10.4266/acc.2024.00052](https://doi.org/10.4266/acc.2024.00052). Referenced 16.10.2026.

Kazemi, M., Froutan, R., & Bagheri Moghadam, A. (2024). Impact of Inspiratory Muscle Training and Positive Expiratory Pressure on Lung Function and Extubation Success of ICU Patients: a Randomized Controlled Trial. Archives of Academic Emergency Medicine, 12(1), e59. [https://doi.org/10.22037/aaem.v12i1.2331](https://doi.org/10.22037/aaem.v12i1.2331). Referenced 1.10.2026.

Réginault, T., Martinez Alejos, R., Coueron, R., Burle, J. F., Boyer, A., Frison, E., & Vargas, F. (2024). Impacts of three inspiratory muscle training programs on inspiratory muscles strength and endurance among intubated and mechanically ventilated patients with difficult weaning: a multicentre randomised controlled trial. Journal of Intensive Care, 12(1), 28. [https://doi.org/10.1186/s40560-024-00741-3](https://doi.org/10.1186/s40560-024-00741-3). Referenced 1.10.2026

Wang, S. J., Fang, T. P., Rowley, D. D., Liu, N. W., Chen, J. O., Liu, J. F., & Lin, H. L. (2025). Inspiratory muscle training facilitates liberation from mechanical ventilation in subacute critically ill patients-a randomized controlled trial. Frontiers in Medicine, 11, 1503678. [https://doi.org/10.3389/fmed.2024.1503678](https://doi.org/10.3389/fmed.2024.1503678). Referenced 1.10.2026.

Picture 1. Microsoft. Illustrative image of lungs. Photo. Stock Images

ChatGPT was used to assist with translating, improving linguistic clarity, and revising the structure.