Effects of Expiratory Muscle Strength Training on Swallowing in Survivors of Critical Illness: A Protocol for a Systematic Review and Meta-Analysis

Background and AimsPost Extubation Dysphagia (PED) is a common consequence of mechanical ventilation. Muscular weakness and atrophy are potential causes. Expiratory Muscle Strength Training (EMST) is a technique whereby a subject exhales against a resistance, strengthening the muscles of expiration. There is evidence that EMST causes activation and hypertrophy of the muscles of swallowing, with clinical evidence that it improves swallowing in certain populations. The aim of this systematic review is to collate the existing literature concerning evaluation of swallowing after extubation, and whether EMST positively affects these measures.MethodsWe will perform a systematic review of the literature by searching electronic databases (Pubmed, Medline, EMBASE, and the Cochrane Library), for articles where EMST has been performed (alone or in conjunction with inspiratory muscle training), in patients who have been liberated from a period of mechanical ventilation. We will identify studies that evaluate swallowing after extubation, listing the methods used to evaluate swallowing and data will be extracted from studies evaluating the impact EMST has on these measures.ResultsWe will undertake meta-analysis if data permits. Risk of bias will be assessed using the Risk of Bias 2 tool or the Newcastle Ottawa Score for randomized and non-randomized trials. We will use The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence.ConclusionThe results of this systematic review will enable us to assess the current literature on the use of EMST in critical care, and whether the intervention improves swallowing and respiratory outcomes. Trial Registration: PROSPERO registration: 42023444479.ConclusionThe results of this systematic review will enable us to assess the current literature on the use of EMST in critical care, and whether the intervention improves swallowing and respiratory outcomes. Trial Registration: PROSPERO registration: 42023444479.