Electronic inspiratory muscle training in hospitalized patients: a systematic review

Abstract

Introduction: Respiratory muscle weakness is common in hospitalized patients, particularly in intensive care units, and is associated with worse clinical outcomes, such as prolonged mechanical ventilation and length of hospital stay. Inspiratory muscle training is a rehabilitation strategy performed using mechanical or electronic devices, the latter offering greater capacity for monitoring and load adjustment. Objective: To critically analyze the evidence on the effectiveness of inspiratory muscle training using electronic devices compared with control conditions (sham training, T-piece/spontaneous breathing, or usual care/conventional physiotherapy) in hospitalized patients. Methods: We searched MEDLINE (via PubMed), Embase, LILACS, and PEDro from inception to June 2026, without date or language limits, for randomized controlled trials in hospitalized patients. Risk of bias was assessed with RoB 2 and certainty of evidence (CoE) with GRADE; random-effects meta-analyses (DerSimonian--Laird) were performed. Results: Eight randomized controlled trials (458 participants) were included. Maximal inspiratory pressure may increase after the intervention (MD 6.89 cmH₂O; 95%CI 0.11 to 13.67; low CoE). The evidence was very uncertain about shorter mechanical ventilation weaning time in the intervention group (MD −5.69 days; 95%CI −8.84 to −2.55; very low CoE). Weaning success did not differ between groups (RR 1.27; 95%CI 0.79 to 2.05; very low CoE).  Conclusion: Electronic inspiratory muscle training may improve inspiratory muscle strength and reduce mechanical ventilation weaning time in hospitalized patients. The certainty of evidence ranged from low to very low; the findings should be interpreted with caution. PROSPERO CRD42024539420.