Temporal evolution of diaphragm thickness and diaphragm excursion among subjects hospitalized with COVID-19: A prospective observational study

Hadda, Vijay; Raja, Arun; Suri, Tejas M; Khan, Maroof Ahmad; Mittal, Saurabh; Madan, Karan

doi:10.1016/j.resmer.2022.100960

Cited by 10 publications

(6 citation statements)

References 26 publications

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“…Several studies are addressing patients after severe COVID-19 disease or patients hospitalized during COVID-19 infection ( 28 , 29 ). Direct viral infiltration has been proven in histologic specimen also showing degeneration of myofibres and muscular dystrophy.…”

Section: Resultsmentioning

confidence: 99%

Decreased phrenic nerve compound muscle action potential, inspiratory muscle strength, and exercise capacity after COVID-19

Vonbank,

Nics,

Zwick

et al. 2024

Front. Neurol.

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ObjectivesRespiratory muscle weakness with higher ventilatory demands were reported even in patients recovering from only mild COVID-19 symptoms. Aim of this study was to assess the function of phrenic nerve and inspiratory respiratory muscle as well as cardiopulmonary exercise capacity in patients with prolonged exertional dyspnea after COVID-19 infection.MethodsIn this observational exploratory study, electrophysiological examination of the phrenic nerve, inspiratory muscle capacity as well as lung function test, 6-min walk distance (6MWD) and cardiopulmonary exercise test, have been performed in 22 patients post COVID-19 diagnosis (post-CoV).ResultsExercise capacity (peak workload, Wpeak % predicted and peak oxygen uptake, VO2peak % predicted) were significantly affected in the post-CoV patients (61.8 ± 23.3 Wpeak % and 70.9 ± 22.3 VO2peak %). Maximum inspiratory pressure (MIP) was reduced (60.1 ± 25.5 mbar). In 6 of the 22 patients the electrophysiological response of the phrenic nerve was pathologically decreased (reduced compound muscle action potential, CMAP), while nerve conduction velocity (NCV) was normal, which corresponds to reduced muscle fiber contraction capacity. Positive relationships were demonstrated between 6MWD and MIP (rs = 0.88) as well as quality of life questionnaire (CRQ) and MIP (rs = 0.71) only in patients with reduced CMAP.DiscussionRespiratory muscle weakness and exercise capacity is associated with reduced phrenic nerve CMAP without signs of neuropathy. This indicates that muscle fiber pathology of the diaphragm may be one pathophysiological factor for the prolonged respiratory symptoms after COVID-19 infections.

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Section: Resultsmentioning

confidence: 99%

Decreased phrenic nerve compound muscle action potential, inspiratory muscle strength, and exercise capacity after COVID-19

Vonbank,

Nics,

Zwick

et al. 2024

Front. Neurol.

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“…A decrease in diaphragm muscle significantly increases the risk of pneumonia, and low thickness and density at CT are predictors for a severe form of COVID-19 ( 28 ). Diaphragm thickness at the end of expiration decreased In COVID-19 patients, and the thickening proportion increased ( 29 ). Various pathophysiological mechanisms are involved in the damage to the respiratory muscles that occurs with COVID-19, such as the decreased contractility of the respiratory muscles, myopathy of the respiratory muscles caused by the virus, unilateral paralysis of diaphragm due to unilateral injury of the phrenic nerve, severe atrophy and weakness due to dysfunction of the diaphragm, and baseline respiratory muscle weakness ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

The Effects of a Pulmonary Rehabilitation Programme on Functional Capacity and Strength of Respiratory Muscles in Patients with Post-COVID Syndrome

Vranić,

Biloglav,

Medaković

et al. 2024

Slovenian Journal of Public Health

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Aim The aim of this study was to estimate the effects of a pulmonary rehabilitation programme (PR) on the functional capacity and respiratory muscle strength of patients with post-COVID syndrome. Methods A cross-sectional study was conducted using hospital data on patients who participated in a pulmonary rehabilitation programme at the Clinic for Lung Diseases, University Hospital Centre Zagreb, Croatia, between January 2021 and December 2022. Data on the spirometry, respiratory muscle strength, and functional exercise capacity of patients were collected at baseline and three weeks after the start of rehabilitation. The study included 80 patients (43 females, 37 males) with a mean age of 51±10 years. Results A significant increase in respiratory muscle strength (P<0.001) was observed after pulmonary rehabilitation, with effect sizes ranging from small to large (Cohen’s d from 0.39 to 1.07), whereas the effect for PImax expressed as a percentage was large (Cohen’s d=0.99). In addition, the pulmonary rehabilitation programme significantly improved the parameters of the six-minute walk test in patients, and the parameters of lung function, FVC, FEV1, and DLCO also improved significantly after PR (P<0.05). Conclusion The results showed that the pulmonary rehabilitation programme has clinically significant effects on functional capacity and respiratory muscle strength in patients with post-COVID syndrome.

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“…Diaphragmatic excursion is 1 cm–2 cm during tidal breathing and 7 cm–11 cm during deep inspiration in healthy subjects ( 40 ). On the other hand, diaphragm dysfunction is observed in 10% of the patients with COVID-19 in the critical unit and it has been reported that the diaphragm thickness declines during the hospital stay ( 9 , 41 , 42 ). Despite the long-term implications are still unclear, the participants of our study presented significant less excursion in deep breathing consistent with the lung morphological alterations observed in LUS exam.…”

Section: Discussionmentioning

confidence: 99%

Clinical and functional status of patients with severe COVID-19 pneumonia: an observational study at 2–3 months following discharge

Castillo Sánchez,

Camarasa,

Barbeta Sánchez

et al. 2023

Front. Rehabil. Sci.

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IntroductionCritically ill COVID-19 patients present long-term sequelae that affect their everyday life. This study aimed to describe the clinical and functional status of patients with severe COVID-19 pneumonia at 2–3 months post discharge from a Spanish critical care unit.MethodsWe collected retrospective data from 58 patients admitted to the critical care unit with diagnosis of severe respiratory failure due to COVID-19. Only patients who required invasive (IMV) or noninvasive ventilation (NIV) during their hospital stay were included. The following data were collected 2–3 months after hospital discharge: respiratory signs and symptoms, lung ultrasound (LUS) and diaphragm ultrasound images, blood test analysis, lung function parameters (spirometry and DLCO), exercise capacity (6 min walk test and sit-to-stand test), level of physical activity and health-related quality of life.ResultsWe found clinical symptoms and lung structural alterations in LUS images of 26 patients (48.1%). Those presenting LUS abnormalities had longer length of stay in hospital (p = 0.026), functional alterations in spirometry (p < 0.01) and decreased diaphragm excursion (p = 0.029). No significant alterations were observed in blood test analysis, exercise capacity, level of physical activity and health-related quality of life.ConclusionsA significant part of the patients admitted to a critical care unit continue to present clinical symptoms, pulmonary morphological abnormalities, and lung function alterations 2–3 months post discharge. This study corroborates that assessing the functional status of the survivors is essential to monitor the evolution of pulmonary sequelae.

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Temporal evolution of diaphragm thickness and diaphragm excursion among subjects hospitalized with COVID-19: A prospective observational study

Cited by 10 publications

References 26 publications

Decreased phrenic nerve compound muscle action potential, inspiratory muscle strength, and exercise capacity after COVID-19

Decreased phrenic nerve compound muscle action potential, inspiratory muscle strength, and exercise capacity after COVID-19

The Effects of a Pulmonary Rehabilitation Programme on Functional Capacity and Strength of Respiratory Muscles in Patients with Post-COVID Syndrome

Clinical and functional status of patients with severe COVID-19 pneumonia: an observational study at 2–3 months following discharge

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