Project 4A: Inspiratory Muscle Training and Diaphragm Strength

Inclusion Criteria: * presence in the surgical or trauma ICU * age of ≥18 years * received mechanical ventilation (MV) for 3 days and expected to survive ICU stay * ability to obtain informed consent from patient or proxy Exclusion Criteria: * Inability to speak and understand English * Uncontrollable source of sepsis with imminent death (e.g., irreversible disease state, unresectable dead bowel) * Receiving "comfort care only" or have advanced care directives limiting resuscitative efforts * Known HIV infection with CD4 count \< 200 cells/mm * Organ transplant recipients on immunosuppressive agent(s), * Known pregnancy * Unable to follow simple, one-step commands, such as "breathe in as hard as you can!" * Prior arrangements to be transferred to other facilities before 28 days of treatment * Contraindications to being disconnected from MV for sham or inspiratory muscle strength training treatment * Unstable or "difficult airway" at 3 days of ICU care defined by ICU protocol, predicted to last for more than 72 hours * Ongoing use of vasopressor or vasodilatatory agents for unstable blood pressure. (beyond minimal intermittent amount or "renal perfusion dose," * Severe cardiac dysrhythmias * Esophageal varices or recent esophageal or gastric surgery, * Upper-airway issues that would be aggravated by inserting esophageal pressure transducers * Unstable neck/cervical anatomy that might be adversely impacted by bilateral magnetic stimulation of phrenic nerves at the neck * Acu…