Diaphragm dysfunction as a potential determinant of dyspnea on exertion in patients 1 year after COVID-19-related ARDS

Spießhoefer, Jens; Friedrich, J.; Regmi, Binaya; Geppert, Jonathan Enriquez; Jörn, Benedikt; Kersten, Alexander; Giannoni, Alberto; Boentert, Matthias; Marx, Gernot; Daher, Ayham; Dreher, Michael

doi:10.1186/s12931-022-02100-y

Cited by 24 publications

(13 citation statements)

References 14 publications

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“…Our group had previously reported diaphragm dysfunction with impaired volitional diaphragm function and control as a potential determinant of exertional dyspnea after COVID-19 illness in a hypothesis-generating research letter ( 12 ). To further investigate the potential role of diaphragm dysfunction on otherwise unexplained dyspnea, the present study used a multimodal approach using state-of-the-art assessments, including both volitional and nonvolitional invasive measures, to determine diaphragm muscle strength in patients previously hospitalized for the management of COVID-19 and its relationship to exertional dyspnea.…”

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confidence: 99%

Diaphragm Muscle Weakness Might Explain Exertional Dyspnea 15 Months after Hospitalization for COVID-19

Regmi

Friedrich

Jörn

et al. 2023

Am J Respir Crit Care Med

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Rationale Dyspnea is often a persistent symptom after acute coronavirus disease (COVID-19), even if cardiac and pulmonary function are normal. Objectives This study investigated diaphragm muscle strength in patients after COVID-19 and its relationship to unexplained dyspnea on exertion. Methods Fifty patients previously hospitalized with COVID-19 (14 female, age 58 ± 12 yr, half of whom were treated with mechanical ventilation, and half of whom were treated outside the ICU) were evaluated using pulmonary function testing, 6-minute-walk test, echocardiography, twitch transdiaphragmatic pressure after cervical magnetic stimulation of the phrenic nerve roots, and diaphragm ultrasound. Diaphragm function data were compared with values from a healthy control group. Measurements and Main Results Moderate or severe dyspnea on exertion was present at 15 months after hospital discharge in approximately two-thirds of patients. No significant pulmonary function or echocardiography abnormalities were detected. Twitch transdiaphragmatic pressure was significantly impaired in patients previously hospitalized with COVID-19 compared with control subjects, independent of initial disease severity (14 ± 8 vs. 21 ± 3 cm H 2 O in mechanically ventilated patients vs. control subjects [ P = 0.02], and 15 ± 8 vs. 21 ± 3 cm H 2 O in nonventilated patients vs. control subjects [ P = 0.04]). There was a significant association between twitch transdiaphragmatic pressure and the severity of dyspnea on exertion ( P = 0.03). Conclusions Diaphragm muscle weakness was present 15 months after hospitalization for COVID-19 even in patients who did not require mechanical ventilation, and this weakness was associated with dyspnea on exertion. The current study, therefore, identifies diaphragm muscle weakness as a correlate for persistent dyspnea in patients after COVID-19 in whom lung and cardiac function are normal. Clinical trial registered with www.clinicaltrials.gov (NCT 04854863).

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confidence: 99%

Diaphragm Muscle Weakness Might Explain Exertional Dyspnea 15 Months after Hospitalization for COVID-19

Regmi

Friedrich

Jörn

et al. 2023

Am J Respir Crit Care Med

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“…Regmi and colleagues were drawn to this hypothesis partly as a result of initial investigations in 10 patients, which they have already reported ( 2 ) and which are included again in the current study. However, other data also make this a plausible hypothesis, including the direct identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 4 of 26 patients in whom postmortem diaphragm biopsies were available and, more importantly, a specific pattern of fibrosis (and corresponding gene expression) compared with patients who succumbed to non–COVID-related acute lung injury ( 3 ).…”

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confidence: 68%

Diaphragm Dysfunction as a Contributor to Breathlessness after COVID-19 Infection

Polkey

2023

Am J Respir Crit Care Med

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“…This could be corroborated by the observed reduced VO 2 p values in many of them, and by the fact that this parameter can get better with physical training [ 39 , 40 , 41 ]. A possible alternative might lie in an altered central control of ventilation [ 42 , 43 , 44 , 45 ] or in an underlying vascular dysfunction, described in post-MIS-C children [ 23 ].…”

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confidence: 99%

Cardiopulmonary Exercise Testing in Children and Young Adolescents after a Multisystem Inflammatory Syndrome: Physical Deconditioning or Residual Pathology?

Gentili

Calcagni

Cantarutti

et al. 2023

JCM

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Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that imposes a long-term follow-up. The purpose of our pilot study is to evaluate the usefulness of the cardiopulmonary stress test (CPET) in the follow-up after MIS-C. All patients admitted for MIS-C in our hospital in the 12 months preceding the date of observation were considered for inclusion in the study. Pre-existing cardio-respiratory diseases and/or the lack of collaboration were the exclusion criteria. At enrolment, each subject passed a cardiological examination, rest ECG, echocardiogram, 24 h Holter-ECG, blood tests, and a CPET complete of spirometry. A total of 20 patients met the inclusion criteria (11.76 ± 3.29 years, 13 male). In contrast to the normality of all second-level investigations, CPET showed lower-than-expected peakVO2 and peak-oxygen-pulse values (50% of cases) and higher-than-expected VE/VCO2-slope values (95% of cases). A statistically significant inverse correlation was observed between P-reactive-protein values at admission and peakVO2/kg values (p = 0.034), uric acid values at admission, and peakVO2 (p = 0.011) or peak-oxygen-pulse expressed as a percentage of predicted (p = 0.021), NT-proBNP values at admission and peakVO2 expressed as a percentage of predicted (p = 0.046). After MIS-C (4–12 months) relevant anomalies can be observed at CPET, which can be a valuable tool in the follow-up after this condition.

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Diaphragm dysfunction as a potential determinant of dyspnea on exertion in patients 1 year after COVID-19-related ARDS

Cited by 24 publications

References 14 publications

Diaphragm Muscle Weakness Might Explain Exertional Dyspnea 15 Months after Hospitalization for COVID-19

Diaphragm Muscle Weakness Might Explain Exertional Dyspnea 15 Months after Hospitalization for COVID-19

Diaphragm Dysfunction as a Contributor to Breathlessness after COVID-19 Infection

Cardiopulmonary Exercise Testing in Children and Young Adolescents after a Multisystem Inflammatory Syndrome: Physical Deconditioning or Residual Pathology?

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