Marlow

Each year, approximately 200,000 adults admitted to intensive care in the UK require mechanical ventilation to assist their breathing. Research indicates many of these patients develop weakness in their diaphragm, the main muscle used for breathing, which can lead to longer ventilator use, extended hospital stays, and increased risks of complications or death. Researchers aim to study a new breathing exercise program that specifically strengthens the diaphragm, as current exercises often focus on less effective muscles and may cause distress. Participants will undergo inspiratory muscle training IMT where they breathe against resistance using a device. The study will test four different resistance levelsranging from no load to 45% of the participants maximal inspiratory pressureto find the optimal level that works the diaphragm effectively without overusing other chest and neck muscles. This procedure, including muscle activity measurements and patient feedback on the exercise experience, will be repeated one to three times over seven days with at least 24 hours between sessions. During the study, muscle effort will be measured with a small tube inserted into the nostril and electrodes placed on the chest and neck. Patients will also rate the difficulty and unpleasantness of each exercise level using a scale and provide feedback through verbal and non-verbal communication methods. Researchers will track diaphragm activation, other muscle activity, and patient experience up to seven days. The study focuses on patients who are difficult to wean from mechanical ventilation and have a tracheostomy.