Inspiratory Muscle Training Prevents Diaphragmatic Atrophy in Mechanically Ventilated COVID-19 Patients

El Naggar, Toqa Emad; Obaya, Hany Ezzat; Ismail, Azza Fekry; Azzam, Rashida El Said; El Naggar, Abdulrahman Emad

doi:10.21608/ijma.2021.84944.1339

Inspiratory Muscle Training Prevents Diaphragmatic Atrophy in Mechanically Ventilated COVID-19 Patients

Document Type : Original Article

Authors

¹ Department of Physical Therapy for Internal Medicine, Critical Care and Elderly, Faculty of Physical Therapy, Modern University for Technology and Information, Egypt

² Department of Cardiopulmonary Disorders, Faculty of Physical Therapy, Cairo University, Egypt

³ Department of Anaesthesia and Critical Care, Faculty of Medicine, Al-Azhar University, Egypt

⁴ House Officer, Damietta Faculty of Medicine, Al-Azhar University, Egypt

10.21608/ijma.2021.84944.1339

Abstract

Background: Unloading the diaphragm by mechanical ventilation results in diaphragmatic dysfunction and atrophy, a condition recognized in critical care settings as ventilator-induced diaphragmatic dysfunction (VIDD). This condition contributes to prolonged mechanical ventilation, extubation failure and higher risk of mortality.
The aim of The Study: The current study aimed to investigate the effectiveness of inspiratory muscle training in preventing or reversing diaphragmatic atrophy in mechanically ventilated COVID-19 patients.
Materials and Methods: 55 intubated, mechanically ventilated patients with hypoxic respiratory failure due to COVID-19 were randomly assigned into study (n = 32) and control (n = 23) groups. The former received inspiratory muscle training with the routine physiotherapy programme and the latter received routine physiotherapy only. Diaphragmatic thickness was measured and compared in both groups using ultrasonography.
Results: In the study group, diaphragmatic thickness at end of inspiration and expiration significantly increased by 14% and 8% respectively (p < 0.001). The increase in thickness fraction for this group (7.5%) was statistically insignificant (p > 0.05). In the control group, there was a significant decrease in all three parameters (p < 0.001).
Conclusion: Inspiratory muscle training by adjusting the ventilator’s trigger sensitivity is a safe, effective and feasible method that can successfully prevent diaphragmatic atrophy in mechanically ventilated, COVID-19 patients.

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