Pulmonary function and respiratory muscle strength at hospital discharge in patients with COVID-19 after admission to the Intensive Care Unit

Authors

DOI:

https://doi.org/10.1590/1809-2950/21020629022022PT

Keywords:

COVID-19, Respiratory Function Tests, Respiratory Muscles, Critical Care

Abstract

The aim of this study was to describe pulmonary function and respiratory muscle strength (RMS) at hospital discharge of patients with severe COVID-19 cases and correlate with peripheral muscle strength, time on mechanical ventilation (MV) and hospital stay and use of medications.This is a cross-sectional study including patients who were admitted to the ICU for COVID-19. Theassessment at hospital discharge included the following variables: RMS, pulmonary function, and peripheral muscle strength [Medical Research Council score and handgrip dynamometry]. Twenty-five patients were included, with a mean age of 48.7±12.3 years. It was observed that 72% of patients had restrictive ventilatory disorder, in addition to reduced RMS [maximum inspiratory pressure (MIP) of 74% and maximum expiratory pressure (MEP) of 78% out of the predicted value]. RMS (MIP and MEP, respectively) correlated negatively with time on MV (r=-0.599, p=0.002; r=-0.523, p=0.007) and hospital stay (r=-0.542, p=0.005; r=-0.502, p=0.01), and positively with FVC (r=0.825, p=0.000; r=0.778, p=0.000), FEV1 (r=0.821, p=0.000; r=0.801, p=0.000), PEF (r=0.775, p=0.000; r=0.775, p=0.000) and handgrip strength (r=0.656, p=0.000; r=0.589, p=0.002).We conclude that patients with severe COVID-19 cases presented, at the time of hospital discharge, reduced RMS and changes in lung function, and a negative correlation between RMS and time on IMV and hospital stay, and a positive correlation with lung function and hand grip strength.

Downloads

Download data is not yet available.

References

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506. DOI:https://doi.org/10.1016/S0140-6736(20)30183-5.

Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J 2020; 55(6). DOI: 10.1183/13993003.01217-2020.

Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20(4):425-434. DOI:https://doi.org/10.1016/S1473-3099(20)30086-4.

You J, Zhang L, Ni-jia-Ti M, Zhang J, Hu F, Chen L, et al. Anormal pulmonary function and residual CT abnormalities in rehabilitating COVID-19 patients after discharge. J Infect 2020; 81(2):e150-e152. DOI: 10.1016/j.jinf.2020.06.003.

American Thoracic Society/European Respiratory, S., ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166(4): 518-624. DOI: 10.1164/rccm.166.4.518.

Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res 1999; 32(6):719-27. DOI:https://doi.org/10.1590/S0100-879X1999000600007.

Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 2019; 200(8):e70-e88. DOI: 10.1164/rccm.201908-1590ST.

Pereira CAC, Sato T, Rodrigues SC. New reference values for forced spirometry in white adults in Brazil. J Bras Pneumol 2007; 33(4):397-406. DOI: 10.1590/s1806-37132007000400008.

De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 2002; 288(22):2859-67. DOI: 10.1001/jama.288.22.2859.

Borges RB, Mancuso ACB, Camey AS, Leotti VB, Hirakata VN, Azambuja GS, Castro SMJ. Power and Sample Size for Health Researchers: uma ferramenta para cálculo de tamanho amostral e poder do teste voltado a pesquisadores da área da saúde. . Clinical & Biomedical Research 2021; 40(4):247-253. DOI:https://doi.org/10.22491/2357-9730.109542.

Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012; 24(3):69-71.

Huang Y, Tan C, Wu J, Chen M, Wang Z, Luo L, et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir Res 2020; 21(1):163. DOI: 10.1186/s12931-020-01429-6.

Supinski GS, Callahan LA. Diaphragm weakness in mechanically ventilated critically ill patients. Crit Care 2013; 17(3):R120. DOI: 10.1186/cc12792.

Petrof BJ, Jaber S, Matecki S. Ventilator-induced diaphragmatic dysfunction. Curr Opin Crit Care 2010; 16(1):19-25. DOI: 10.1097/MCC.0b013e328334b166.

Jaber S, Jung B, Matecki S, Petrof B. Clinical review: ventilator-induced diaphragmatic dysfunction-human studies confirm animal model findings! Crit Care 2011; 15(2):206. DOI: 10.1186/cc10023.

Frija-Masson J, Debray MP, Gilbert M, Lescure FX, Travert F, Borie R, et al. Functional characteristics of patients with SARS-CoV-2 pneumonia at 30 days post-infection. Eur Respir J. 2020; 56(2). DOI: 10.1183/13993003.01754-2020.

Li X, Wang C, Kou S, Luo P, Zhao M, Yu K. Lung ventilation function characteristics of survivors from severe COVID-19: a prospective study. Crit Care 2020; 24(1):300. DOI: https://doi.org/10.1186/s13054-020-02992-6.

Zhao Y, Shang Y, Song W, Li Q, Xie H, Xu Q, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine 2020; 25:100463. DOI: 10.1016/j.eclinm.2020.100463.

Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 8(4):420-422. DOI: 10.1016/S2213-2600(20)30076-X.

Yao XH, Li TY, He ZC, Ping YF, Liu HW, Yu SC, et al. [A pathological report of three COVID-19 cases by minimal invasive autopsies]. Zhonghua Bing Li Xue Za Zhi 2020; 49(5):411-417. DOI: 10.3760/cma.j.cn112151-20200312-00193.

González J, Benítez ID, Carmona P, Santisteve S, Monge A, Moncusí-Moix A, et al. Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19: A 3-Month Prospective Cohort. Chest 2021; 160(1):187-198. DOI: 10.1016/j.chest.2021.02.062.

Published

2022-08-08

Issue

Section

Original Research

How to Cite

Pulmonary function and respiratory muscle strength at hospital discharge in patients with COVID-19 after admission to the Intensive Care Unit. (2022). Fisioterapia E Pesquisa, 29(2), 169-175. https://doi.org/10.1590/1809-2950/21020629022022PT