Short of Breath for the Long Haul: Diaphragm Muscle Dysfunction in Survivors of Severe COVID-19 as Determined by Neuromuscular Ultrasound

Farr, Ellen; Wolfe, Alexis R.; Deshmukh, Swati; Rydberg, Leslie; Soriano, Rachna; Walter, James M.; Boon, Andrea J.; Wolfe, Lisa F.; Franz, Colin K.

doi:10.1101/2020.12.10.20244509

Cited by 3 publications

(5 citation statements)

References 11 publications

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“…Respiratory muscle weakness of unknown aetiology has also been reported in COVID-19 patients (Farr et al, 2020), which might offer an explanation for abnormal lung volumes observed in our cohort (Hart et al, 2002). Consistent with previous accounts demonstrating abnormal lung volumes in individuals recovering from moderateto-critical COVID-19 (Ekbom et al, 2021;González et al, 2021;Huang et al, 2021;Smet et al, 2021), we observed FRC, TLC, VC and RV that were below clinically relevant thresholds in several of our participants recovering from mild-to-moderate illness.…”

Section: Discussionsupporting

confidence: 91%

“…However, the proportion of SARS‐CoV‐2 participants demonstrating abnormal lung volumes in our study was lower than that found in accounts including hospitalized cases of greater severity (Ekbom et al., 2021 ; González et al., 2021 ; Huang et al., 2021 ; Smet et al., 2021 ). Further examination of the mechanisms underlying reduced lung volumes (i.e., fibrotic/inflammatory changes to the pulmonary interstitium, respiratory muscle weakness attributed to neuromuscular manifestations of the virus, and microcirculatory changes leading to atrophy of type II myofibres; Farr et al., 2020 ), via diagnostic imaging and/or tests of respiratory muscle strength, is needed in individuals experiencing post‐acute COVID‐19 syndrome.…”

Section: Discussionmentioning

confidence: 99%

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Evidence for impaired chronotropic responses to and recovery from 6‐minute walk test in women with post‐acute COVID‐19 syndrome

Baranauskas

Carter

2021

Experimental Physiology

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New Findings What is the central question of this study? Are chronotropic responses to a 6‐minute walk test different in women with post‐acute coronavirus disease 2019 (COVID‐19) syndrome compared with control subjects? What is the main finding and its importance? Compared with control subjects, the increase in heart rate was attenuated and recovery delayed after a 6‐minute walk test in participants after infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Women reporting specific symptoms at time of testing had greater impairments compared with control subjects and SARS‐CoV‐2 participants not actively experiencing these symptoms. Such alterations have potential to constrain not only exercise tolerance but also participation in free‐living physical activity in women during post‐acute recovery from COVID‐19. Abstract The short‐term cardiopulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) are well defined. However, the implications of cardiopulmonary sequelae, persisting beyond acute illness, on physical function are largely unknown. Herein, we characterized heart rate responses to and recovery from a 6‐minute walk test (6MWT) in women ∼3 months after mild‐to‐moderate SARS‐CoV‐2 infection compared with non‐infected control subjects. Forty‐five women ( n = 29 SARS‐CoV‐2; n = 16 controls; age = 56 ± 11 years; body mass index = 25.8 ± 6.0 kg/m 2 ) completed pulmonary function testing and a 6MWT. The SARS‐CoV‐2 participants demonstrated reduced total lung capacity (84 ± 8 vs. 93 ± 13%; P = 0.006), vital capacity (87 ± 10 vs. 93 ± 10%; P = 0.040), functional residual capacity (75 ± 16 vs. 88 ± 16%; P = 0.006) and residual volume (76 ± 18 vs. 93 ± 22%; P = 0.001) compared with control subjects. No between‐group differences were observed in 6MWT distance ( P = 0.194); however, the increase in heart rate with exertion was attenuated among SARS‐CoV‐2 participants compared with control subjects (+52 ± 20 vs. +65 ± 18 beats/min; P = 0.029). The decrease in heart rate was also delayed for minutes 1–5 of recovery among SARS‐CoV‐2 participants (all P < 0.05). Women reporting specific symptoms at the time of testing had greater impairments compared with control subjects and SARS‐CoV‐2 participants not actively experiencing these symptoms. Our findings provide evidence for marked differences in chronotropic responses to and recovery from a 6MWT in women several months after acute SARS‐CoV‐2 infection.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Evidence for impaired chronotropic responses to and recovery from 6‐minute walk test in women with post‐acute COVID‐19 syndrome

Baranauskas

Carter

2021

Experimental Physiology

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“…[2][3][4] Postacute sequelae of COVID-19 (PASC) affect up to two out of three of patients, up to 60% of which describe persistent dyspnoea more than 60 days after infection. 5 Here, we describe a case of COVID-19-related unilateral diaphragmatic paralysis causing PASC dyspnoea.…”

Section: Introductionmentioning

confidence: 94%

“…A preprint describing a cohort of 25 patients with COVID-19 treated with mechanical ventilation identified a high burden of diaphragmatic abnormalities. 5 Another study describes 1527 patients with COVID-19, 1.5% of which were diagnosed with diaphragmatic dysfunction on CT scan. 17 These reports differ from ours as each patient was treated with CPAP or mechanical ventilation, both known risk factors for the development of diaphragmatic dysfunction, while our patient received no non-invasiveventilation or mechanical ventilation.…”

Section: Case Reportmentioning

confidence: 99%

Diaphragmatic paralysis in COVID-19: a rare cause of postacute sequelae of COVID-19 dyspnoea

et al. 2021

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We describe a 56-year-old female patient hospitalised with COVID-19 in April 2020 who had persistent respiratory symptoms after radiographic and microbiologic recovery. X-ray of the chest demonstrated an elevated right hemidiaphragm while fluoroscopy confirmed unilateral diaphragmatic paralysis. Symptoms resolved gradually, concurrent with restoration of right hemidiaphragm function. Thus, we describe a rare cause of postacute sequelae of COVID-19 dyspnoea.

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“…Comienzan a aparecer un goteo de teorías que justifican el daño residual neurológico o de otros órganos diana, que necesitarán ratificación [19][20][21].…”

Section: ¿Cuáles Son Las Más Importantes Manifestaciones Respiratorias?unclassified

Post-COVID syndrome: A reflection and opinion paper

Bouza

Moreno²,

Ramos³

et al. 2021

Rev Esp Quimioter

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A high proportion of people who have suffered from COVID-19 report, after recovery from the acute phase of the disease, clinical manifestations, both subjective and objective, that continue beyond 3 weeks or even 3 months after the original clinical disease. There is still no agreed nomenclature to refer to this condition, but perhaps the most commonly used is post-COVID syndrome. The Scientific Committee on COVID of the Madrid College of Physicians (ICOMEM) has discussed this problem with a multidisciplinary approach in which internists, infectious disease specialists, psychiatrists, pneumologists, surgeons, geriatricians, pediatricians, microbiologists, family physicians and other specialists have participated, trying to gather the existing information and discussing it in the group. The clinical manifestations are very variable and range from simple fatigue to persistent fibrosing lung lesions with objective alterations of pulmonary function. Post-COVID syndrome seems to be particularly frequent and severe in adults who have required admission to Intensive Care Units and has a peculiar behavior in a very small group of children. The post-COVID syndrome, which undoubtedly exists, is at first sight not clearly distinguishable from clinical manifestations that which occur after other acute viral diseases and after prolonged stays in ICUs due to other diseases. Therefore, it offers excellent research opportunities to clarify its pathogenesis and possibly that of other related entities. It is possible that progressively there will be an increased demand for care among the millions of people who have suffered and overcome acute COVID for which the health authorities should design mechanisms for the agile management of care that will possibly require well-coordinated multidisciplinary groups. This paper, structured in questions on different aspects of the post-COVID syndrome, attempts to stage the current state of this problem

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Short of Breath for the Long Haul: Diaphragm Muscle Dysfunction in Survivors of Severe COVID-19 as Determined by Neuromuscular Ultrasound

Cited by 3 publications

References 11 publications

Evidence for impaired chronotropic responses to and recovery from 6‐minute walk test in women with post‐acute COVID‐19 syndrome

Evidence for impaired chronotropic responses to and recovery from 6‐minute walk test in women with post‐acute COVID‐19 syndrome

Diaphragmatic paralysis in COVID-19: a rare cause of postacute sequelae of COVID-19 dyspnoea

Post-COVID syndrome: A reflection and opinion paper

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