Inspiratory Muscle Training in Hospitalized Patients With Heart Failure Awaiting Advanced Therapies

Prior treatment

• Patients with an expectedpreoperative inpatient hospital stay of less than 10 days, based onreview of clinical status, treatment plan, and timing of expected surgery
• Abdominal surgery during present admission

Other illness

• Patients discharged from the hospital to await advanced therapies (LVAD or heart transplant)
• Untreated hypertension, defined as systolic blood pressure consistently \>140 mmHg or diastolic blood pressure consistently \>90 mmHg in the absence of antihypertensive therapy.
• Patients with planned multiple organ transplant (e.g. heart and kidney, heart and lung)
• A burst eardrum that has not fully healed, or any other condition of the eardrum
• Patients with worsening heart failure signs and symptoms after IMT

Other

• Patients with acute pneumothorax
• Presence of acute rib fracture(s)
• Patients with acute cerebrovascular accident
• Acute delirium
• Perforated tympanic membrane
• Hemodynamic instability
• Patients currently requiring mechanical ventilatory support
• Patients with asthma who suffer from frequent severe exacerbations
• Patients with marked elevated left ventricular end-diastolic volume and pressure
• If you have suffered from or are likely to suffer from costochondritis

• 18 years old or older
• Able to provide consent and willing to participate in study procedures
• Currently hospitalized awaiting advanced therapies (LVAD or heart transplant)
• Diagnosed with NYHA class III or IV heart failure
• Able to follow instructions including the use of the Borg Dyspnea scale
• Physically able to independently hold and use the IMT
• Patients will undergo screening with or without active PT orders. To be enrolled in the study, patient must have an active physical therapy order. . If no active order exists, one will be requested from medical team following the screening and prior to enrollment.
• Participants must meet institutional criteria for participation in physical therapy and mobility activities prior to enrollment and before each IMT session. Medical stability may include:
  • Mean arterial pressure (MAP) ≥ 60 mmHg and ≤ 120 mmHg
  • Resting heart rate between 40 and 140 beats per minute
  • No evidence of active myocardial ischemia or unstable angina
  • No uncontrolled atrial or ventricular arrhythmias
  • No escalating vasopressor or inotropic support at time of intervention
  • Oxygen saturation ≥ 94% on current oxygen support
  • Respiratory rate between 8 and 35 breaths per minute
  • Ability to follow simple commands and participate in study procedures
  • No acute neurologic, respiratory, or hemodynamic deterioration requiring immediate escalation of care
  • Clearance by the treating medical team to participate in rehabilitation activities