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Diaphragm Dysfunction as a Determinant of Persisting Dyspnoea in Patients One Year after Invasive Mechanical Ventilation Due to COVID-19 Related ARDS

33 Pages Posted: 10 Sep 2021

See all articles by Jens Spiesshoefer

Jens Spiesshoefer

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine

Janina Friedrich

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine

Benedikt Jörn

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine

Binaya Regmi

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine

Jonathan Enriquez-Geppert

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine

Alexander Kersten

University of Münster - University Hospital Muenster

Alberto Giannoni

Scuola Superiore Sant' Anna

Matthias Boentert

University of Münster - University Hospital Muenster

Gernot Marx

RWTH Aachen University - RWTH University Hospital Aachen

Nikolaus Marx

RWTH Aachen University - RWTH University Hospital Aachen

Ayham Daher

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine

Michael Dreher

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine

More...

Abstract

Background: Some patients with coronavirus disease 2019 (COVID-19) experience prolonged fatigue and dyspnoea without objective impairment of pulmonary or cardiac function. This study determined diaphragm function and its central voluntary activation as a possible pathophysiological correlate after severe COVID-19 acute respiratory distress syndrome (ARDS).

Methods:Ten patients with severe COVID-19 ARDS treated with invasive mechanical ventilation (IMV) (6 female, age 56±14 years, 63±45 days of IMV) and ten matched healthy controls underwent pulmonary function tests (PFTs), 6-minute walk test, echocardiography, diaphragm ultrasound, and invasive recording of twitch transdiaphragmatic pressure (twPdi) following magnetic diaphragm stimulation. Twitch interpolation was used to determine the diaphragm voluntary activation index (DVAI); reflecting central diaphragm activation.

Findings: One year post discharge, neither PFTs nor echocardiography were indicative of significant abnormalities in severe COVID-19 survivors. However, six patients reported persisting dyspnoea on exertion (severe in two, moderate in four). On ultrasound, the diaphragm thickening ratio was lower in patients versus controls (1.87±0.37 vs. 2.76±0.72; p<0.01), and diaphragm excursion velocity during a maximum sniff manoeuvre was associated with dyspnoea. TwPdi following cervical magnetic stimulation did not differ between patients and controls overall, but twPdi half relaxation time progressively increased in parallel with dyspnoea severity (ANOVA p=0.03), while sniff Pdi progressively decreased (ANOVA p=0.05). DVAI was lower in patients versus controls (30±27% vs 79±6%, p<0.01) and was associated with dyspnoea (ANOVA p=0.05).

Interpretation: Inspiratory muscle dysfunction with impaired central voluntary activation of the diaphragm is present one year after severe COVID-19 ARDS treated with IMV, and relates to dyspnoea.

Trial Registration: This prospective case-control study was registered with number, (NCT04854863)

Funding: None to declare.

Declaration of Interest: The authors have no conflicts of interest to disclose.

Ethical Approval: This study was approved by the local ethics committee (Ethikkommission an der Medizinischen Fakultät der Rheinisch-Westfälischen Technischen Hochschule Aachen, CTCA-A-Nr. 20-515, AZ EK 443/20).

Keywords: coronavirus, mechanical ventilation, long COVID, diaphragm function, pulmonary function, dyspnoea.

Suggested Citation

Spiesshoefer, Jens and Friedrich, Janina and Jörn, Benedikt and Regmi, Binaya and Enriquez-Geppert, Jonathan and Kersten, Alexander and Giannoni, Alberto and Boentert, Matthias and Marx, Gernot and Marx, Nikolaus and Daher, Ayham and Dreher, Michael, Diaphragm Dysfunction as a Determinant of Persisting Dyspnoea in Patients One Year after Invasive Mechanical Ventilation Due to COVID-19 Related ARDS. Available at SSRN: https://ssrn.com/abstract=3920921 or http://dx.doi.org/10.2139/ssrn.3920921

Jens Spiesshoefer (Contact Author)

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine ( email )

Germany

Janina Friedrich

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine ( email )

Germany

Benedikt Jörn

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine ( email )

Germany

Binaya Regmi

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine ( email )

Germany

Jonathan Enriquez-Geppert

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine ( email )

Germany

Alexander Kersten

University of Münster - University Hospital Muenster ( email )

Muenster
Germany

Alberto Giannoni

Scuola Superiore Sant' Anna ( email )

Italy

Matthias Boentert

University of Münster - University Hospital Muenster ( email )

Muenster
Germany

Gernot Marx

RWTH Aachen University - RWTH University Hospital Aachen ( email )

Germany

Nikolaus Marx

RWTH Aachen University - RWTH University Hospital Aachen ( email )

Germany

Ayham Daher

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine ( email )

Germany

Michael Dreher

RWTH Aachen University - Department of Pneumology and Intensive Care Medicine

Germany