Respiratory Muscle Weakness Research Articles

Respiratory muscle weakness, reduced exercise capacity, and impaired lung functions in long-term post-COVID-19 patients

<b>Background: </b>Many post-COVID-19 patients experienced long-term effects with symptoms lasting for more than three months including fatigue and dyspnea. There is scarce information in the literature on respiratory muscle strength, lung functions, exercise capacity, and the degree of dyspnea in long-term post-COVID-19 patients after two years of recovery.<br /> <b>Objectives:</b> This study aims to assess respiratory muscle function, lung function, exercise capacity, and respiratory symptoms for two years after COVID-19 infection.<br /> <b>Methodology:</b> This is an observational cross-sectional study that included 49 post-COVID-19 patients two years after recovery. Participants were categorized into two groups (hospitalized, n = 18 and non-hospitalized, n = 31). Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), a six-minute walk test, and pulmonary function tests, were performed to assess ventilation function and exertion intolerance. The presence of respiratory symptoms was evaluated using the St. George’s respiratory questionnaire.<br /> <b>Results:</b> Diffusion impairment was the most common lung function abnormality found among all post-COVID-19 patients (32%) followed by restrictive pattern (19%). Two percent showed small airway disease, and no obstructive patterns were found. A reduced exercise capacity (the six-minute walk distance < 85% of predicted value) was found in 44% of post-COVID-19 patients. Respiratory muscle weakness was reported in twenty post-COVID-19 patients (41%), and MIP and MEP were significantly lower than predicted values (p < 0.001). Dyspnea was the most experienced respiratory symptom with (42%) followed by cough (22%) and wheezing (8%).<br /> <b>Conclusion: </b>Our findings showed low exercise capacity, abnormal lung functions, and respiratory muscle weakness in post-COVID-19 patients two years after recovery. We strongly recommend periodic lung function and respiratory muscle testing in symptomatic post-COVID-19 patients.

Identifying Unmet Needs for Patients Living With Neuromuscular Disease and Respiratory Muscle Weakness: A Qualitative Study

Identifying Unmet Needs for Patients Living With Neuromuscular Disease and Respiratory Muscle Weakness: A Qualitative Study

Two Brothers With ADSS1 Myopathy: A Report of Clinical, Radiological, and Autopsy Findings.

ADSS1 myopathy, previously known as adenylosuccinate synthetase-like 1 (ADSSL1) myopathy, is an autosomal recessive muscle disease caused by variants in ADSS1 (adenylosuccinate synthase 1). ADSS1 myopathy is complicated by respiratory muscle weakness or cardiomyopathy as well as limb muscle weakness. We analyzed two siblings with ADSS1 myopathy, both harboring compound heterozygous pathogenic variants (c.781G>A/c.919delA) in ADSS1 and provided details of their phenotypes together with muscle imaging and autopsy findings. Although it was reported that ADSS1 myopathy usually began with lower limb muscle weakness, our cases showed early involvement of the cervical paraspinal muscle, triceps brachii muscle, flexor digitorum superficialis and profundus muscles, rectus abdominis muscle, gluteus maximus and medius muscles, and cardiomyopathy. While a previous study reported that the trunk and hip muscles were relatively spared, atrophy of paraspinal muscles, gluteus medius and maximus muscles, and adductor muscles were observed. Our two siblings allowed for long-term follow-up and will be useful reference cases. We evaluated the frequency of fibers with nemaline bodies in various autopsied muscles and found that the ratio of fibers with nemaline bodies was lower compared to other nemaline myopathies. Postmortem examination revealed, for the first time, nemaline bodies in the diaphragm and myocardium, associated with respiratory failure and cardiomyopathy.

Pulmonary function and exercise capacity in mild early-onset idiopathic scoliosis: a case‒control study

BackgroundEarly-onset idiopathic scoliosis (EOIS) is a spinal deformity that develops before the age of 10 years with unknown etiology. Scoliosis can lead to respiratory muscle weakness and decreased motor function. Nevertheless, the effects of mild EOIS on pulmonary function and functional exercise capacity remain poorly understood. Early detection is crucial to mitigate its impact on children’s health and prevent progression. The aim of this study was to investigate the characteristics of pulmonary function and exercise capacity in children with EOIS and to identify influencing factors.Methods52 children with mild EOIS and 52 healthy controls matched for age and sex were recruited.Participants underwent pulmonary function test, a 6-minute walk test (6MWT) and Borg score assessments to evaluate subjective fatigue before and after 6MWT. Differences in forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, peak expiratory flow (PEF) and six-minute walking distance (6MWD) were compared between the two groups. Imaging parameters were measured from full spinal X-ray orthopantomograms taken in the standing position for the case group. Independent samples t-tests were used to analyze differences between the two groups, followed by multiple linear regression analyses to identify the influencing factors.ResultsThe case group exhibited significantly lower FEV1/FVC and 6MWD but a higher Borg score compared to the control group (P = 0.009, P = 0.015, P < 0.001). Within the case group, the FEV1/FVC was significantly decreased in the right thoracic scoliosis subgroup compared with the left thoracic scoliosis subgroup (P = 0.006). Height, Cobb’s angle and PEF were significant factors affecting the 6MWD of EOIS (P = 0.003, P = 0.005, P = 0.002), FVC was related to the height, side bend position and side bend direction (P < 0.001, P = 0.030, P = 0.013), and FEV1 was affected by age, weight and type of side bend (P = 0.016, P = 0.019, P = 0.016).ConclusionsMild pulmonary and exercise capacity restrictions appear early in mild EOIS. Exercise capacity is influenced by lung function and exhibits a negative correlation with the severity of scoliosis. Pulmonary function in right thoracic scoliosis was significantly lower than that in left thoracic scoliosis. Early identification of these functional declines is crucial for implementing timely interventions to prevent further deterioration.

Inspiratory Muscle Training and Its Impact on Weaning Success in Mechanically Ventilated ICU Patients: A Systematic Review

Background/Objectives: A major importance is now accorded to respiratory muscle weakness resulting from exposure to invasive mechanical ventilation (IMV) in intensive care unit patients. Some authors suggested that Inspiratory Muscle Training (IMT) could increase the chances of weaning off IMV. This systematic review examined the efficacy of IMT on weaning success in mechanically ventilated patients. Methods: A literature search was conducted on PubMed, Cochrane, and PEDro until June 2023. Weaning success, maximum inspiratory pressure (MIP), and Rapid Shallow Breathing Index (RSBI) were the outcome measures included. Results: Seven randomized controlled trials, including 517 participants under IMV for at least 48 h, were included in the review. From a qualitative point of view, a significant increase in MIP and a significant decrease in RSBI were found in the intervention group during the analysis. However, weaning success was the same between the intervention and control groups. No significant association was found between weaning success and the increase of MIP or the decrease of RSBI. Furthermore, it could not be demonstrated that a positive change in MIP or RSBI would increase the weaning success rates. Conclusions: From a qualitative point of view, IMT is effective in increasing MIP and decreasing RSBI. However, IMT has no significant impact on weaning success. Further research is recommended to analyze the effect of IMT on weaning success.

Exploring Peripheral and Respiratory Muscle Weakness and Functional Impairments in ICU Patients: Insights From a Resource-Constrained Setting.

The aim of this study was to explore peripheral and respiratory muscle structure and strength from unit admission to hospital discharge among ICU patients in a resource-constrained setting. Prospective, observational study. Tertiary academic hospital. Newly intubated critically ill adults admitted to the medical and surgical ICUs and expected to be mechanically ventilated for more than 48 hours were included in the study. Ultrasonography of the right hemi-diaphragm and quadriceps muscles were taken at admission for 3 consecutive days. Respiratory and peripheral muscle strength were evaluated using the Medical Research Council-Sum Score, dynamometry and maximal inspiratory pressure (MIP) at awakening, ICU discharge and hospital discharge. Forty-five participants were included, with a median (interquartile range) age of 34.5 (24.3-47.4) years and 73% were male. Most of the change in diaphragm thickness was observed on day 3, with 5 (22%) participants showing a decrease of more than 10% from baseline. Minimal changes in rectus femoris cross-sectional area were noted during the first 3 days. Eleven participants (44%) presented with ICU-acquired weakness at awakening, which decreased to 7 (29%) participants at ICU discharge and 5 (24%) participants at hospital discharge. The mean ± sd percentage of predicted quadriceps force was 22.2 ± 5.1 N at hospital discharge. The mean ± sd percentage of predicted MIP scores was 29.6% ± 10.5% at ICU discharge and 29.1% ± 8.6% at hospital discharge. Patients discharged from the ICU in a resource-constrained setting presented with peripheral and respiratory muscle weakness, with minimal change in muscle structure shown by ultrasonography, despite short ICU stays, low Acute Physiology and Chronic Health Evaluation II scores, and a relatively young age. Future research should explore whether these findings indicate a distinct phenotype of critical illness in such environments.

Unraveling Ventilator-Induced Diaphragmatic Dysfunction: A Comprehensive Narrative Review on Pathogenesis, Diagnosis and Management of Ventilator-Induced Diaphragmatic Dysfunction.

Mechanical ventilation (MV) is a crucial intervention for patients with respiratory failure to ensure optimal gas exchange. However, there is strong evidence that MV exerts significant structural and functional alterations on the diaphragm, leading to a notable decline in its contractile force and the consequent atrophy of its muscle fibers. This condition, referred to as ventilator-induced diaphragmatic dysfunction (VIDD), is an integral factor contributing to challenges in weaning patients off MV, a reduction in their quality of life, and escalated Mortality Risks. This review highlights the complications of MV, with a focus on VIDD and its clinical implications. It explores bedside diagnostic tools for VIDD and examines exercise-based interventions aimed at preventing or reversing daiphragmatic weakness. Rehabilitation programs, including early mobilization and inspiratory muscle training (IMT) for critically ill patients, have the potential to prevent or mitigate the adverse effects of prolonged Mechanical ventilator and improve clinical outcomes. Numerous studies have demonstrated that these interventions are both safe and feasible, offering benefits such as enhanced physical functioning, reduced duration of mechanical ventilation, and shorter stays in intensive care and hospital settings. However, despite these demonstrated advantages, the implementation of rehabilitation programs remains infrequent in routine clinical practice, often hindered by various perceived barriers. Recognizing and addressing respiratory muscle weakness is crucial, as it represents a reversible and treatable factor that can significantly improve patient outcomes.

Efgartigimod Successfully Ameliorated Acute Exacerbation of Myasthenia Gravis with Anti-muscle-specific Kinase Antibodies

We herein report two patients with anti-muscle-specific kinase (MuSK) antibody-positive myasthenia gravis who experienced rapid deterioration of weakness, particularly respiratory muscle weakness, necessitating non-invasive positive pressure ventilation (NIPPV) and were treated with efgartigimod. After treatment initiation, a rapid reduction in IgG levels and recovery from clinical symptoms were observed. NIPPV was no longer required two to three weeks after the first infusion of efgartigimod. These findings suggest that the reduction of IgG levels using efgartigimod is a good treatment option in patients with myasthenia gravis positive for anti-MuSK antibodies, even during the acute phase of the disease.

An Observational Study of Lung Function Alterations in Stone Quarry Workers of North Karnataka.

Introduction The disorganized stone quarrying industry creates much noise and pollution for valuable commodities such as coal, metal, and stones throughout the extraction process. It produces dust particles with varying aerodynamic sizes between 1 and 100 microns composed of silica, organic solvents, and heavy metals. The objective of this study is to determine the effectsof stone dust on pulmonary functions and their correlations with sociodemographic variables among quarry stone workers. Methodology The study group consisted of 50 male subjects working in a quarry exposed to stone dust, and the control group comprised 50 matched male subjects who were hospital employees. Detailed anthropometric and physiological dataand pulmonary functions were recorded using computerized Spiro Excel. The parameters recorded were forced vital capacity (FVC) in mL, forced expiratory volume in the first second (FEV1) in mL, the percentage of forced expiratory volume in one second (FEV1%), and maximum expiratorypressure (MEP) in mmHg recorded using the modified Blacks apparatus. Observation There was a significant reduction inpeak expiratory flow rate (PEFR) (p=0.004) in the study group (138.4±62.80 L/minute) as compared to the control group (272.8±327.6 L/minute). Also, there was a significant reduction in MEP (p=0.16) in the study group (23.6±12.4 mmHg) as compared to the control group (38.4±227 mmHg). There was no significant decrease in other parameters in the study group compared to the controls. Conclusion Lung function parameters were negatively correlated with the duration of exposure. We attribute this reduction in lung function tests to respiratory muscle weakness. Therefore, breathing exercises must be available to such workers to strengthen the respiratory muscles and improve lung function tests.

Respiratory Muscle Strength as a Predictor of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is closely related to skeletal muscle dysfunction, and the evaluation of respiratory muscle function has recently been recommended. We aimed to investigate the effects of respiratory muscle dysfunction on clinical outcomes. We retrospectively reviewed the medical records of patients with COPD whose respiratory muscle strength was measured between June 2015 and December 2021. We then analysed the effects of respiratory muscle strength on moderate-to-severe exacerbations after adjusting for confounding factors, including sex, age, forced expiratory volume in 1-s percent predicted, hand grip strength, and skeletal muscle mass index. We also compared the temporal relationship between respiratory and systemic skeletal muscle dysfunctions. Respiratory muscle weakness (RMW) was observed in 48.1% (100) of the 208 patients. Low percent predicted maximal inspiratory pressure was an independent risk factor for moderate-to-severe exacerbations within 1 year in the Cox regression analysis (adjusted hazard ratio per 1 standard deviation increase, 0.521; 95% confidence interval, 0.317-0.856). Approximately half of the patients already exhibited RMW at the mild systemic skeletal muscle dysfunction, while those with sarcopenia had higher RMW rates. More patients with RMW experienced progressive systemic skeletal muscle dysfunction within 1 year compared to those without RMW. Lower respiratory muscle strength is associated with an increased risk of exacerbation. Respiratory muscle function could serve as a marker of disease status and early prognosis in COPD.

Anti-mitochondrial M2 antibody-positive myositis may be an independent subtype of autoimmune myositis.

It is still unknown whether anti-mitochondrial M2 antibody (AM2A)-positive myositis is an independent subtype of autoimmune myositis (AIM). As such, the aim of this study is to better characterize the clinicopathological features in a large cohort of patients. This study utilized the muscle biopsy samples from AM2A-positive patients, which were sent to the National Center of Neurology and Psychiatry for diagnostic purposes from January 2008 to December 2020. The clinicopathologic information of 201 patients were compared with those who were diagnosed with immune-mediated necrotizing myopathy (IMNM), anti-synthetase syndrome, or dermatomyositis. AM2A-positive patients had the longest pre-biopsy disease duration (PBDD) at 48.7 ± 63.0months and the highest frequency of arrhythmia of 51.1%. Necrotic and/or regenerating fibers were seen in 93.5% and membrane attack complex sarcolemmal deposits were noted in 43.3%, similar to IMNM. Furthermore, AM2A-positive patients with shorter PBDD showed more CD8-positive lymphocyte infiltrates. Clinically, shorter PBDD was associated with higher serum creatine kinase levels, whereas longer PBDD was associated with a higher frequency of arrhythmia. Principal component analysis separated disease groups with high weight of muscle pathology components on two-dimensional plotting, although AM2A-positive myositis and IMNM partly overlapped. On logistic regression model analysis, we obtained high sensitivity (0.846) and specificity (0.842) for distinguishing them using clinical and pathological variables. This largest cohort study suggests that AM2A-positive myositis may be an independent subtype of AIM characterized by a chronic myositis with IMNM-like pathology, along with a high prevalence of cardiac involvement and respiratory muscle weakness.

Effects of Long COVID in Patients with Severe Coronavirus Disease 2019 on Long-Term Functional Impairments: A Post Hoc Analysis Focusing on Patients Admitted to the ICU in the COVID-19 Recovery Study II.

Background/Objectives: This study investigated the prevalence of functional impairments and the effects of long COVID on long-term functional impairments in patients with severe COVID-19. Methods: We conducted a nationwide multicenter cohort study in collaboration with nine hospitals, collecting data using self-administered questionnaires from participants aged 20 years or older who were diagnosed with COVID-19, admitted to the intensive care unit (ICU) between April 2021 and September 2021, and discharged alive. Questionnaires regarding daily life, sequela, and functional impairments were mailed to patients in August 2022. The effects of long COVID on functional impairments were examined using a multivariate logistic regression analysis. Results: The survey was completed by 220 patients, with a mean of 416 days after discharge. Among respondents, 20.5% had physical impairments (n = 45), 35.0% had mental disorders (n = 77), and 42.7% had either (n = 94). Furthermore, 77.7% had long COVID (171/220), and the most common symptom was dyspnea (40.0%). The multivariate analysis showed that fatigue/malaise, upper respiratory tract symptoms, myalgia, muscle weakness, decreased concentration, sleep disorder, brain fog, and dizziness were risk factors for functional impairments at one year. Conclusions: Many patients with severe COVID-19 admitted to the ICU still suffered from post-intensive care syndrome even after one year, which manifested in combination with direct symptoms of the original disease, such as long COVID.

Analysis of Respiratory Muscle Strength Training in Amyotrophic Lateral Sclerosis (ALS) Patients: A Systematic Review.

Respiratory muscle weakness is a significant contributor to morbidity and mortality in amyotrophic lateral sclerosis (ALS) patients. Respiratory muscle strength training (RMST) has emerged as a potential therapeutic approach to mitigate respiratory muscle weakness in ALS. Still, its efficacy and safety remain unclear due to conflicting evidence and methodological heterogeneity in existing studies. A systematic review was conducted across three databases (PubMed (United States National Library of Medicine, Bethesda, MD, USA), Embase (Elsevier, Amsterdam, Netherlands), and Cochrane Library (Cochrane, Alberta, Canada)) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess the effectiveness of RMST in ALS patients. Eligible studies included comparative studies for RMST, focusing on outcomes such as maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC), and ALS Functional Rating Scale (ALSFRS-R). Quality assessment was performed using the Cochrane Risk of Bias tool. This study included six studies, including 183 patients with a mean age of 58.0 years (49.6 to 63.2) and a mean follow-up time of 21.2 weeks (eight to 52). The average mean difference for ALSFRS-R (three studies), MIP (three studies), MEP (three studies), and FVC (two studies) were 2.062 (0.04 to 5.3), 2.285 (-8.145 to 10.8), 19.435 (10.86 to 21.7), and 7.23 (3.6 to 10.86), respectively. Complications related to RMST were poorly reported across studies. Secondary outcomes, such as depression scores, blood oxygen levels, and heart rate variability, showed promising trends but lacked consistency. Despite positive findings on respiratory muscle strength, RMST's efficacy in ALS management remains inconclusive. Challenges include methodological heterogeneity, limited sample sizes, and inadequate reporting of complications. Future research should focus on standardized protocols, larger sample sizes, longer follow-ups, and comprehensive assessment of adverse effects to clarify the role of RMST in ALS treatment.

Inspiratory muscle training facilitates liberation from mechanical ventilation in subacute critically ill patients-a randomized controlled trial.

Patients undergoing mechanical ventilation often develop rapid diaphragmatic atrophy, respiratory muscle weakness, and dysfunction, which are associated with prolonged duration of ventilation. This study aimed to evaluate whether Inspiratory Muscle Training (IMT) facilitates weaning from mechanical ventilation and enhances muscle strength in critically ill, subacute adult patients, while examining the relationship between IMT and relevant clinical laboratory values. In this randomized clinical trial, patients admitted to the intensive care unit requiring mechanical ventilation for more than 2 days, with stable hemodynamics and resolved acute conditions, were enrolled. Participants were randomly assigned to the IMT or no-IMT group. The IMT group received training twice daily, 5 days a week, for three consecutive weeks. The primary outcome was ventilator duration. The primary outcome measure was the number of days until liberation from mechanical ventilation. The secondary outcomes of interest were respiratory muscle strength and biomarker levels. Thirty-three subjects (17 in the IMT group, 16 in the no-IMT group) were included in the final analysis. The IMT group had significantly shorter ventilator days (12.6 ± 5.2 vs. 18.1 ± 8.8, p = 0.04). IMT intervention significantly reduced rapid shallow breathing index and improved respiratory muscle strength, with greater maximum inspiratory pressure (p < 0.01), maximum expiratory pressure (p = 0.03), and peak expiratory flow (p = 0.01). A moderate positive correlation was observed between IMT and increased creatinine levels (rs = 0.54, p = 0.01), whereas the no-IMT group showed a reduction. IMT significantly shortened ventilator duration and improved respiratory muscle strength. A moderate correlation between increased creatinine levels and respiratory muscle strength was observed, suggesting that creatinine may be a potential biomarker for muscle recovery during IMT. This study was registered at ClinicalTrials.gov (NCT06611683).

Chronic inflammatory demyelinating polyneuropathy associated with podocytopathy: a clinical case with literature review

Chronic imflammatory demyelinating polyneuropathy (CIPD) is a heterogenous group of disimmune polyneuropathies, characterised by progressive or relapsing-remitting disease course, with electrophysiologically and pathomorphologically detected peripheral nerve demyelination. Immunotherapy is considered reasonable in CIDP. CIDP associated with antibodies against nodo-paranodal proteins, namely, NF155, CNTN1, Contactin associated protein has been described amongst the rare atypical CIDP subtypes. The detection of antibodies against nodo-paranodal proteins might have a predictive value for a more severe disease course with resistance to corticosteroid and/or IVIG treatment. Herein we report a case of severe relapsing-remitting CIDP, characterized by respiratory muscle weakness requiring assisted ventilation, with a previous history of proteinuria, later also diagnosed with Minimal change disease (MCD).

Effectiveness of breathing exercises on urinary symptoms, muscle activity, and strength in women with multiple sclerosis and urinary incontinence—a study protocol for a randomized controlled trial study

BackgroundUrinary incontinence (UI) is a common and debilitating condition among people with multiple sclerosis (MS) and is more prevalent among women. Over the past decade, numerous studies have investigated the effects of pelvic floor muscle training (PFMT) as a treatment for UI in people with MS. MS negatively impacts pulmonary function even in the early stages of the disease and people with MS may experience respiratory muscle weakness. Considering the synergy between the pelvic floor muscle (PFM) and respiratory muscles, this trial will evaluate the effects of PFMT and breathing exercises on PFM activity and strength, diaphragm activity, and urinary symptoms in women with MS who experience UI.MethodsFifty women with MS and UI will participate in this parallel randomized controlled trial, comprising 32 treatment sessions. The intervention group consists of PFMT and breathing exercises, and the control group includes PFMT. The severity of UI symptoms, PFM activity, diaphragm activity, and PFM strength will be evaluated using the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, ultrasound imaging, and modified Oxford grading scale, respectively before and after the intervention.DiscussionThe current trial is designed to examine the effects of a combined exercise program for UI in women with MS. It is hypothesized that using breathing exercises in conjunction with PFM exercises will improve patient symptoms compared to PFMT alone.Trial registrationThe trial was registered in the Iranian Registry of Clinical Trials with code IRCT20180916041051N3 and was approved on 23 May 2024.Graphical

Polysomnographic titration of non-invasive ventilation in motor neurone disease (3TLA): study protocol for a randomised controlled trial

BackgroundNon-invasive ventilation (NIV) uses positive pressure to assist people with respiratory muscle weakness or severe respiratory compromise to breathe. Most people use this treatment during sleep when breathing is most susceptible to instability. The benefits of using NIV in motor neurone disease (MND) are well-established. However, uptake and usage are low (~ 19%) and there is no consensus on how to best implement NIV in MND in Australia. Consequently, clinical practice models are highly variable. Our team has recently provided evidence that specific and individualised NIV titration using a sleep study (polysomnography; PSG) leads to better outcomes in people with MND. However, for this clinical practice model to result in sustained benefits, evidence of effectiveness across multiple sites, as well as culture and practice change, must occur.MethodsA two-arm, assessor-blinded, individual participant randomised controlled trial in MND care centres across Australia will be undertaken. Two-hundred and forty-four participants will be randomised (1:1) to either the intervention group (PSG-assisted commencement of NIV settings; PSG) or a control group (sham PSG). Participants will be asked to use their NIV device for 7 weeks and will then return for follow-up assessments. Respiratory, sleep and patient-reported outcome measures will be collected at baseline and follow-up. The primary aim is to determine if the proportion of participants using NIV for > 4 h/day during the intervention period is higher in the PSG than the control group. A process evaluation, health economic evaluation and 12-month cohort follow-up will be undertaken and reported separately.DiscussionThe results of this trial will demonstrate the effects of PSG-assisted titration of NIV on usage of NIV in people with MND. We hypothesise that the PSG intervention will improve synchrony between the user and the machine, which will lead to greater NIV usage compared to the control group.Trial registrationClinicalTrials.gov NCT05136222. Registered on November 25, 2021.

Identifying Respiratory Muscle Strength in Middle Aged Males and Females Based on Reference Equation

Respiratory muscle strength is an essential part of respiratory system evaluation as the process of ventilation eventually depends on the muscles of respiration. Aging reduces the muscle mass commonly referred to as ‘sarcopenia’. Thus, the middle-aged population goes under a sequential change of thoracic cages that affects the respiratory system. There are various tools available for assessment of the strength of these respiratory muscles. However, the feasibility of applying these tools is limited by their availability in various clinical settings, which poses a significant drawback when assessing their effectiveness. The reference equations on the other hand which address this issue are available to assess the respiratory muscle strength (RMS) using the maximal mouth pressures as maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). The MIP and MEP are calculated on the basis of individual’s age, height and weight. The present study thus applied the available equation to assess the RMS which included 200 volunteers (100 males and 100 female) with mean age was of 56.67± 6.89 and 58.45± 6.85 for males and females with the average height was of 167.18 ± 3.99 and 159.3 ± 2.74 with the weight of 69.14 ± 3.37 and 60.30 ± 4.08 respectively. The BMI of the study cohort was 24.26±0.70 kg/m2. The mean MIP for males is 93.63 ± 4.84 and mean MEP is 84.84 ± 4.78 while in females the mean MIP was 69.84 ± 2.85 and mean MEP was 63.46 ± 2.86. The equations can further be utilized for identifying individual’s cut off respiratory pressure for evaluating respiratory muscle weakness. It can significantly be of much importance while diagnosing neurologically affected patients for their RMS as it gives an individual’s limit for inspiratory as well as expiratory muscle strength.

Pediatric pneumological aspects in the care of children with neuromuscular diseases with focus on Duchenne muscular dystrophy

Duchenne muscular dystrophy is the most common inherited neuromuscular disease in children. In addition to the progressive loss of motor skills and cardiac involvement, respiratory muscle weakness leads to a restrictive lung disease and cough insufficiency. Specific respiratory interventions have significantly improved survival and quality of life of the affected boys. The pediatric pulmonologist's tasks include monitoring of the lung function, polysomnography, starting and adjusting of non-invasive or invasive nocturnal ventilation and optimizing of secretion management. Providing of vaccinations, enhancing of nutrition, treatment of intercurrent infections, and provision of advice and training are important tasks for the pediatric pulmonologist. This article emphasizes on the tasks for the pediatric pulmonologist in the treatment of children with neuromuscular diseases i. e. Duchenne muscular dystrophy in interaction with the other specialist disciplines.

Respiratory muscle strength, pain and pulmonary complications in adult patients following median sternotomy during hospital stay: a longitudinal observational study

BackgroundPulmonary complications influence morbidity, mortality and hospital stay in patients following cardiac surgery. Acute post-operative pain and less than optimal respiratory muscle strength may affect a patient’s ability to take deep breaths, cough and clear secretions, thereby influencing recovery after surgery. To date, few studies described patients’ pain levels, respiratory muscle strength and the presence of pulmonary dysfunction preoperatively and evaluated the effect of a median sternotomy on parameters at hospital discharge. This study investigates this in patients at a private urban hospital in South Africa.MethodsParticipants were consecutively sampled for this longitudinal observational study and assessed at hospital admission and discharge. The visual analogue scale provides information on participants’ pain levels. Respiratory muscle strength (maximal inspiratory pressure and peak inspiratory flow) was assessed with a POWERbreathe KHI device. The presence of pulmonary complications was determined with a chest X-ray radiographic scoring tool. Descriptive and inferential analyses with significance set at p ≤ 0.05 were performed.ResultsThe population consisted of 61 participants [males: n = 47 (77%)], and the majority underwent coronary artery bypass graft surgery (n = 35, 57%) and had a theatre time of 5.84 (± 1.30) h and time on cardiopulmonary bypass 2.01 (IQR1.14) h. Intensive care stay was 5 (IQR 2.75) days with mechanical ventilation time 17.33 (IQR 11.21) h and hospital stay 9 (IQR 7) days. Forty-one (67.2%) participants had weak respiratory muscles at hospital admission. Respiratory muscle strength reduced significantly between hospital admission and discharge: maximal inspiratory pressure: 55 cmH20 vs 30.66 cmH20, p < 0.001, and peak inspiratory flow: 2.70 l/s vs. 1.66 l/s, p < 0.001. Atelectasis (n = 28, 46, 6%) and pleural fluid (n = 26, 43, 3%) were chest X-ray abnormalities at hospital discharge. Chest X-ray scores (Z = − 5.825, p < 0.001) and pain levels (Z = − 5.867, p < 0.001) increased significantly over time. There was a fair, negative correlation between admission maximal inspiratory pressure and chest X-ray scores, which was statistically significant (r = − 0.356, p = 0.004).ConclusionsRespiratory muscle weakness, abnormal chest X-ray findings and persistent pain were noted in study participants. This study highlights the need for continued rehabilitation services to optimise patient outcomes as it relates to ventilation and pain management.