Respiratory Muscles In Patients Research Articles

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

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. 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. 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). 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.

Reliability of digital filtering on surface electromyographic activity of respiratory muscles in patients with COVID-19

Introduction: Surface electromyography (sEMG) is valuable for assessing respiratory muscle activity, but the influence of electromagnetic fields can impair the accuracy of the signals. This study aims to compare the Root Mean Square (RMS) values of sEMG signals from respiratory muscles in COVID-19 patients receiving oxygen therapy in the ICU before and after digital filtering. Methods: This exploratory analysis is part of a cross-sectional study registered on ClinicalTrials.gov (NCT05572853). sEMG signals from the sternocleidomastoid, scalenus, diaphragm, and rectus abdominis muscles were recorded in COVID-19 patients receiving low-flow oxygen therapy. The RMS data were analyzed and processed using Scilab 6.1.1 software before and after applying a filter with a 60 Hz notch and a passband between 20-500 Hz. Results: 71 patients with a mean age of 55 ± 14 years, predominantly male (73.2%), were included. Muscle’s activity remained unchanged after signal filtering, showing higher RMS intensity (pre-filter/post-filter) for the scalene (14.0 ± 8.6 / 8.5 ± 6.2), sternocleidomastoid (12.0 ± 8.8 / 6.8 ± 7.8), diaphragm (11.7 ± 8.1 / 5.4 ± 7.1), and rectus abdominis (10.4 ± 4.7 / 3.1 ± 1.9) muscles. RMS attenuation was significant for all muscles (p &lt; 0.001), with no agreement between pre- and post-filtering from Bland-Altman analysis. Conclusions: The applied digital filter attenuated RMS values while maintaining the same respiratory muscle activation, enhancing signal identification by reducing noise.

Emergency ultrasound of respiratory muscles: a promising tool for determining the outcomes of COPD exacerbations.

The respiratory muscles of patients with chronic obstructive pulmonary disease (COPD) exhibit structural and functional changes that can be evaluated and monitored by ultrasonography. This single-center, prospective study was conducted in the emergency department (ED) of a tertiary care hospital over an eight-month period (September 2020-May 2021). Diaphragmatic excursions, end-expiratory thickness, and thickening fractions, as well as right and left intercostal muscle thicknesses, of all adult subjects manifesting COPD exacerbation, were assessed. The data were analyzed regarding ward/intensive care unit (ICU) hospitalization or discharge from the ED, mortality, and readmission within 15 days. Sixty-three subjects were recruited for the study. Diaphragmatic excursion, end-expiratory diaphragmatic thickness, and intercostal muscle thickness measurements were significantly different between the ward, ICU, and discharge groups (p < 0.001) but lower in the deceased subjects (all p < 0.05). The diaphragmatic excursion value of 3.25 cm was the threshold value measured for distinguishing discharge from ED, and 1.82 cm was measured for admission to the ICU, both with 100% sensitivity and selectivity (AUC = 1). Diaphragmatic excursion, diaphragmatic end-expiratory thickness, and right and left intercostal muscle thicknesses vary in the prognosis of subjects presenting with COPD exacerbation.

Assessment of the Function of Respiratory Muscles in Patients after COVID-19 Infection and Respiratory Rehabilitation.

The MIP (maximum inspiratory pressure) and MEP (maximum expiratory pressure) are sensitive indicators of respiratory muscle function. The aim of the study was to assess the function of respiratory muscles in patients after COVID-19 infection, before and after hospitalisation at the Pulmonary Rehabilitation Ward. The study was conducted on a group of 19 people with laboratory-confirmed COVID-19 infection, who, in the period from 1 February to 31 May 2021, were hospitalised at the Independent Public Pulmonary Hospital and underwent respiratory rehabilitation in hospital conditions. A statistical analysis was performed using the STATISTICA package, ver. 10. A respiratory pressure meter (RP Check) was used to measure muscle strength. Measurements were performed twice on each patient-before admission and after hospitalisation in the Pulmonary Rehabilitation Ward. We show that conducting pulmonary rehabilitation contributes to the increase in MIP and MEP, which are associated with increased strength of the inspiratory and expiratory muscles. The average value of MIP increased by 11.95 cmH2O and MEP by 26.16 cmH2O. The improvement was visible in both female and male patients. Pulmonary rehabilitation contributes to the improvement of respiratory muscle function indicators among patients after COVID-19 infection. Assessment of the MIP and MEP indices is a simple and quick way to reliably assess the function of the respiratory muscles.

MAIN INDICATORS OF THE OXIDANT-ANTIOXIDANT SYSTEM AND THEIR RELATIONSHIP WITH THE FORCE OF THE RESPIRATORY MUSCLES IN ADULT PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

Background. Currently, pneumonia ranks 4-5 rate in the world in the structure of death causes after cardiovascular and cancer diseases, cerebrovascular pathology, injuries and poisonings.&#x0D; Objective. The aim of the study was to evaluate the indicators of the oxidative-antioxidant system and their relationship with the strength of the respiratory muscles in adult patients with community-acquired pneumonia.&#x0D; Methods. The study was carried out in the period 2017-2020 on the basis of the therapeutic department of the Municipal non-profit enterprise "City Clinical Multidisciplinary Hospital № 25" of Kharkiv City Council. The study involved 52 adult patients with CAP aged 18 to 80 years. The control group consisted of 20 apparently healthy humans. It was determinated the activity of malondialdehyde, catalase and superoxide dismutase, level of reduced glutathione, glutathione reductase and glutathione peroxidase. The assessment of the RM strength was investigated by recording the maximum static pressures at the level of the mouth and nose with “closed” airways using a MicroRPM apparatus on the 1st and 10th days of illness.&#x0D; Results. Dysfunction of expiratory respiratory muscles prevailed in patients with non-severe CAP, and inspiratory respiratory muscles in patients with severe CAP. Were established significant negative correlations of malondialdehyde with indicators of respiratory muscles strength and positive correlations with glutathione reductase, glutathione peroxidase, catalase, and superoxide dismutase.&#x0D; Conclusions. The presence of relationships between pro- and antioxidant indicators and respiratory muscles strength complements the concept of the body's systemic response on pulmonary inflammation – one of the markers of respiratory muscles dysfunction.&#x0D; KEYWORDS: community-acquired pneumonia, respiratory muscles, oxidative-antioxidant system.

Functional State of Respiratory Muscles in Patients with Chronic Obstructive Pulmonary Disease

The objective: to assess the strength of respiratory muscles (RM) in patients with chronic obstructive pulmonary disease (COPD) and determine the role of certain pathogenetic factors of COPD in the development of respiratory muscle dysfunction.Subjects and methods. In in-patient settings, the strength characteristics of respiratory muscles were studied in 85 men aged 39-78 years suffering fromCOPD exacerbation. MicroRPM (CareFusion, UK) was used to determine the levels of maximum inspiratory and expiratory pressures in the oral cavity, maximum rate of their rise during inspiration and expiration as well as the level of intranasal pressure before and after the test with salbutamol.Results. Significant variability in strength characteristics of respiratory muscles was observed depending on the stage of COPD, its phenotype, and the presence of hypoxemia or hypercapnia. In patients at early stage of COPD, only expiratory respiratory muscle dysfunction was documented; at moderate and severe stages, inspiratory and expiratory muscle dysfunction was observed, and at very severe stage – diaphragm dysfunction prevailed. The results of the salbutamol test demonstrated the maximum increase in the strength of respiratory in early and moderate COPD and the minimum increase in extremely severeCOPD indicating the role of the irreversible component of bronchial obstruction in the development of respiratory muscle dysfunction. The emphysematous phenotype of COPD was characterized by inspiratory respiratory muscle dysfunction, while the bronchitic phenotype was characterized by expiratory respiratory muscle dysfunction. In patients with hypoxemia and hypercapnia, the strength of inspiratory respiratory muscle was lower versus normoxemia.

The condition of the respiratory muscles in obstructive sleep disordered breathing according to electromyographic data

Aim . To study functional state of respiratory muscles in patients with obstructive sleep-disordered breathing (oSDB) of varying severity based on changes in electrical activity when using a stepwise-increasing respiratory load. Materials and methods . According to results of cardiorespiratory monitoring, the examined patients were divided into 4 groups. Group 1 included 16 patients without oSDB, group 2 – 16 patients with mild oSDB, group 3 – 8 patients with moderate oSDB, group 4 – 8 patients with severe oSDB. The assessment of electrical activity of inspiratory muscles and expiratory muscles was carried out using electromyography (EMG) when performing tests with a stepwise-increasing inspiratory and expiratory load. Results . During inspiratory test, a decrease in EMG frequency was observed, indicating respiratory muscles fatigue development, with a simultaneous increase in EMG amplitude due to the involvement of additional motoneurons in muscle contraction. In all cases, degree of increase in EMG amplitude prevailed over degree of decrease in EMG frequency. In patients of groups 3 and 4, there were no signs of diaphragm fatigue. Results of expiratory test in group 1, degree of increase in EMG amplitude prevailed over degree of decrease in EMG frequency. In the groups of patients with oSDB, prevalence of decrease in the EMG frequency over increase in EMG amplitude was observed, which indicates development of neuromuscular fatigue of expiratory muscles. Conclusion . Changes in functional state of respiratory muscles are associated with severity of oSDB and are characterized by different dynamics of the electrical activity of inspiratory and expiratory muscles in response to a functional test.

COVID-19 — Is It Time for Exercise Clinicians to Prehabilitate “High Risk” Respiratory Patients?

COVID-19 — Is It Time for Exercise Clinicians to Prehabilitate “High Risk” Respiratory Patients?

Evaluation of the relationship between the parameters of peripheral skeletal and respiratory muscles in patients with chronic obstructive pulmonary disease

To study the relationship between functional and quantitative parameters of the peripheral (limb muscle) and respiratory muscles in COPD patients. 127 patients (98 men/29 women, mean age 67.68.2 years) were under observation without acute COPD. All COPD patients were classified according to GOLD (2019) into groups A, B, C, D. The algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP2) was used to diagnose sarcopenia. The muscle mass was measured using dual energy X-ray absorptiometry (DXA) and the appendicular lean mass index (ASM) was estimated. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured by body plethysmograph MasterScreen Body. Quantitative assessment of thoracic muscle cross-sectional areas were performed using the CT scan using Vidar Dicom Viewer software. Sarcopenia was diagnosed in 43.3% of COPD patients. Respiratory muscle dysfunction was determined in 66.1% of patients with COPD, its probability increased in groups C and D in comparison with groups A and B [chance ratio 6.6 (95% confidence interval 2.915.0); p0.0001]. Correlations between the functional parameters of sarcopenia and respiratory muscle strength as well as between the mass of peripheral skeletal muscles and respiratory muscle area have been established according to the data of computerized tomography (р0.01). Sarcopenia as well as respiratory muscle dysfunction was observed more frequently in persons with severe and extremely severe airway obstruction and in patients with predominantly emphysematic COPD phenotype (p0.01). Sarcopenia is a frequent comorbidity in COPD and its development is connected with the severity of the course of the main disease. Correlation between parameters of peripheral (limb muscle) and respiratory muscles in patients with COPD has been determined.

Comparative analysis of the strength of the respiratory muscles in community-acquired pneumonia with different severity of endogenous intoxication

To assess the strength of the respiratory muscles in patients with community-acquired pneumonia (CAP) with varying severity of endogenous intoxication. In the hospital, 78 men aged 1826 years with CAP were examined. СAP was diagnosed in 56 (72%) patients, severe CAP in 22 (28%). The severity of endogenous intoxication was verified using intoxication indices: hematological index of intoxication (HII), leukocyte index of intoxication (LII), nuclear index of intoxication (NII) and Krebs index. Middleweight molecules (MWM) was determined by spectrophotometry in the serum and the concentration of interleukin (IL)-10 and tumor necrosis factor  (TNF-) by ELISA. The strength of the respiratory muscles was measured on the device Micro RPM (Care Fusion, Great Britain). The maximum expiratory pressure (МЕР), inspiratory pressure (MIP) in the oral cavity, the Maximal Rate of Pressure Development (MRPD) during inhalation (MRPDin) and exhalation (MRPDex), and intranasal test (SNIP) were determined. Statistical processing was performed using descriptive statistics, MannWhitney test, correlation and cluster analysis. Three clusters of endogenous intoxication corresponding to mild, moderate and severe degree were identified. The first cluster was represented only by patients with mild CAP, the second-mild CAP and severe CAP, and the third severe CAP. Dysfunction of the expiratory respiratory muscles prevailed during the height of the disease in patients with the first cluster, and in the second and third inspiratory, including the diaphragm. The level of actually measured values of MIP and SNIP was 68% and 58% of those due to severe endogenous intoxication. Significant negative correlations were established LII, HII, MWM, TNF-, IL-10 с MEP, MRPDex, MIP и SNIP. Respiratory muscle dysfunction remained only expiratory respiratory muscles in convalescents of the first cluster, and expiratory and inspiratory muscles of the second and third cluster. The development of respiratory muscle dysfunction in CAP is associated with the influence of endogenous intoxication factors. The results can be used in personalized programs of rehabilitation.

Acute effects of photobiomodulation therapy applied to respiratory muscles of chronic obstructive pulmonary disease patients: a double-blind, randomized, placebo-controlled crossover trial.

To investigate the effects of photobiomodulation applied to respiratory muscles on lung function, thoracoabdominal mobility, respiratory muscle strength, and functional capacity in COPD patients. This is a randomized double-blind crossover clinical trial. Twelve male COPD patients participated in the study. Participants were randomly allocated to receive two photobiomodulation sessions, 1week apart: (1) an effective photobiomodulation session applied at the main respiratory muscles by means of a cluster with 69 light-emitting diodes (LEDs), containing 35 red (630 ± 10nm; 10mW; 0.2cm2) and 34 near-infrared (830 ± 20nm; 10mW; 0.2cm2) LEDs and (2) a sham photobiomodulation session, following the same procedures without emitting light. The primary outcomes were pulmonary function (spirometric indexes); thoracoabdominal mobility (cirtometry); respiratory muscle strength (maximal respiratory pressures), assessed at three moments: (1) baseline, (2) 1h after intervention, and (3) 24h after intervention; and the functional capacity, assessed by the 6-min walk test (6MWT) at baseline and 24h after intervention. No significant interactions were found for spirometric variables, maximal respiratory pressures, and cirtometry. However, there was a Time × Condition interaction (F = 18.63; p = 0.001; η2p = 0.62) in the walked distance on the 6MWT, with a significant increase after photobiomodulation intervention (p < 0.01) compared with the baseline. Photobiomodulation applied to respiratory muscles was effective in improving acute functional capacity in COPD patients. To the best of our knowledge, this is the first study assessing the effects of photobiomodulation applied to respiratory muscles in patients with COPD.

Electroneuromyographic indices of respiratory muscles in patients with chronic obstructive pulmonary disease

The functional state of respiratory muscles and diaphragm was assessed in 28 patients with chronic obstructive pulmonary disease of 2, 2-3, 3 degrees of severity according to electroneuromyography at the age of 49 to 65 years. The revealed violations of the functional state of the respiratory muscles and the function of external respiration significantly aggravate the progressive nature of the pathological process in the lungs in COPD.

Еlectroneuromyographic Indices of Respiratory Muscles in Patients with Chronic Obstructive Pulmonary Disease

Еlectroneuromyographic Indices of Respiratory Muscles in Patients with Chronic Obstructive Pulmonary Disease

Evaluation of respiratory functions and quality of life in multiple sclerosis patients.

The aim of this study was to evaluate respiratory muscle strength, respiratory functions and quality of life in multiple sclerosis (MS) patients and compare the results with the healthy volunteers. The study included a group of 24 patients diagnosed with MS (16 women, 8 men) with an EDSS score of ≤ 5, who were without clinical respiratory impairment. MS patients were compared with the healthy volunteer group (16 women, 8 men). Respiratory muscle strength and respiratory functions were evaluated with specific devices. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) parameters were measured for the muscle strength. Forced vital capacity (FVC), forced expiratory volume (FEV1), FEV1/FVC, peak expiratory flow, and forced expiratory flow (FEF25-75) parameters were measured for the respiratory functions. Questionnaire SF-36 was applied to evaluate health-related quality of life. A total of 24 MS patients' respiratory function test results were compared with healthy volunteers and significant changes were found at MIP, MEP, and FEV1 parameters. Quality of life was compared between the groups and there was a significant difference in parameters related with physical performance and physical-health-related role limitations. There is an early involvement of the respiratory muscles in patients with MS, yet clinical symptoms appear in later stages. Respiratory functions should be evaluated at the earlier stage of the disease so that rehabilitation can be planned in order to reduce respiratory complications and improve the quality of life in patients.

Regional ventilation redistribution measured by electrical impedance tomography during spontaneous breathing trial with automatic tube compensation**This study was endorsed by the Far Eastern Memorial Hospital Research Ethics Review Committee, approval number: FEMH-IRB-103133-E.

Objective. Automatic tube compensation (ATC) was developed to overcome the flow resistance of endotracheal tube and decrease the imposed work of breathing. Although ATC is used as an evidence-based strategy to predict successful weaning from assisted ventilation, the changes in regional ventilation distribution induced by this technique are not known. We hypothesized that continuous positive airway pressure plus ATC (CPAP + 100%ATC) could reactivate the respiratory muscles in patients with prolonged mechanical ventilation (PMV) more effectively than volume assist-control mandatory ventilation (ACMV). Approach. A total of 16 PMV patients were included. Patients were ventilated under volume ACMV mode and subsequently under CPAP + 100%ATC for 50 min. Two periods of 5 min electrical impedance tomography (EIT) data at the end of each mode were analyzed. Main results. Tidal variations of electrical impedance determined by EIT during CPAP + 100%ATC were significantly smaller than during ACMV (p < 0.001), while no significant differences in end-expiratory lung impedance were found. Regional ventilation was distributed significantly more towards dorsal regions during CPAP + 100%ATC as indicated by the EIT-based index center of ventilation (46.2 ± 5.8 during ACMV versus 51.7 ± 6.5 during CPAP + 100%ATC, values in %, p < 0.001). However, the overall degree of ventilation inhomogeneity was not improved as indicated by the global inhomogeneity index (0.42 ± 0.09 during ACMV versus 0.42 ± 0.06 during CPAP + 100%ATC). The onset of ventilation was significantly less delayed during CPAP + 100%ATC in both ventral and dorsal regions as indicated by the ventilation delay index (ACMV versus CPAP + 100%ATC, 53.0 versus 42.6 in ventral; 50.2 versus 39.3 in dorsal regions; values in %, p < 0.001). Significance. Dorsal redistribution of ventilation and reduction of ventilation delay as identified by EIT indicate that CPAP + 100%ATC was effective in reactivating the respiratory muscles in the PMV patients of the present study.

Deviation in the recovery of the lower limb and respiratory muscles of patients with polymyositis: a preliminary clinical study.

[Purpose] The purposes of this study were to quantify the serial changes in lower limb and respiratory muscle strengths and to evaluate the acute effects of physiotherapy in polymyositis patients. [Subjects and Methods] Five patients (57.6 ± 9.0 years, 50 to 72; four females) received physiotherapy five days a week for four weeks. The lower limb and respiratory muscle strength, the % vital capacity, and the Barthel index were evaluated at baseline and after the intervention. [Results] The patient’s symptoms and creatine kinase values did not change, and after four weeks, all of the patients exhibited significantly increased outcomes compared with the baseline. However, the inspiratory muscle strength of the patients presented smaller improvements than the expiratory muscle strength. [Conclusion] Differential changes in inspiratory and expiratory muscle strength were observed following physiotherapy, and an unbalanced muscle distribution may explain the pathological and therapeutic effects.

Effectiveness of Neuromuscular Electrical Stimulation on Auxiliary Respiratory Muscles in Patients with Chronic Obstructive Pulmonary Disease Treated in the Intensive Care Unit

Effectiveness of Neuromuscular Electrical Stimulation on Auxiliary Respiratory Muscles in Patients with Chronic Obstructive Pulmonary Disease Treated in the Intensive Care Unit

Importance of diaphragm thickness in amyotrophic lateral sclerosis patients with diaphragm pacing system implantation.

Severe respiratory failure develops as a result of the involvement of the respiratory muscles in patients with amyotrophic lateral sclerosis (ALS). Implantation of diaphragm pacing system (DPS) has been carried out on ALS patients since 2005 to avoid these situations, but the importance of diaphragm thickness has not yet been established clearly. We retrospectively evaluated 34 ALS patients who had previously implanted DPS to detect the importance of diaphragm thickness. We investigated the effect of diaphragm thickness, which was measured by preoperative thorax computerized tomography on preoperative respiratory function tests (RFT), arterial blood gas (ABG) analysis, postoperative 3- and 6-month oxygen saturations and mortality. The right diaphragm thickness was calculated as 4.60 (2.95-6.00) mm, while the left diaphragm thickness was 4.10 (2.77-6.00) mm. Six patients died during the follow-up period. We did not detect a significant relationship between ABG parameters, RFT and diaphragm thickness. However, according to our observations, the diaphragm thickness was significantly related to mortality. The right diaphragm was significantly thinner in cases that required preoperative respiratory support and had percutaneous endoscopic gastrostomy. When the cut-off values for the diaphragm thickness were accepted as 3.50 mm, significantly higher mortality among patients below this was observed. Diaphragm thickness is an important criterion in cases for which DPS implantation is planned. We consider that avoidance of DPS implantation is more suitable for cases with a diaphragm thickness below 3.50 mm because of mortality.

Exercise training for pulmonary hypertension: A systematic review and meta-analysis

Exercise training for pulmonary hypertension: A systematic review and meta-analysis

Training of respiratory muscles in patients with multiple sclerosis: a systematic review.

The aim of this systematic review was to summarize the level of evidence and grades of recommendation regarding therapeutic respiratory muscle training interventions in patients with multiple sclerosis (MS). We conducted a search using a number of electronic databases, and the limits of the search were studies published between 1993 and 2013. The selected documents were classified according to grades of recommendation of the Finnish Medical Society Duodecim. The methodological quality of 11 studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. Fifteen trials (6 randomized controlled trials [RCTs], 2 non-RCTs, one quasi-experimental trial, 3 case studies, and 3 systematic reviews) showed clinical changes from pulmonary function outcomes for MS. The reviewed articles covered training protocols that were carried out for 10 weeks to 3 months at a frequency of 7 d/week with one or 2 daily sessions consisting of 3 sets of 10 or 15 repetitions per set at an intensity of 10-60% of the subject's maximum expiratory pressure. It was observed that subjects who had minor scores in the Kurtzke Expanded Disability Status Scale showed changes in maximum inspiratory and expiratory pressures after respiratory muscle training. In future studies, it would be suitable to take into account both inspiratory and expiratory muscle training.