Electrical activity of expiratory muscles in type 2 diabetes mellitus

Aim. To study the functional state of the expiratory muscles in patients with type 2 diabetes mellitus on the basis of changes in their electrical activity when using a functional test with a static expiratory effort. Materials and methods. 47 patients with type 2 diabetes mellitus and 40 patients without disorders of carbohydrate metabolism were examined. To study the electrical activity of the expiratory muscles, surface electromyography (EMG) of the external oblique abdominal muscle (OAM), rectus abdominis muscle (RAM), and internal intercostal muscles (IIM) was performed using a functional test with a static expiratory effort. Results. When performing a functional test with a static expiratory effort in both groups, a decrease in the frequency and an increase in the amplitude of EMG was observed, however, in patients with type 2 diabetes mellitus, these changes were less pronounced. There were also differences in the dynamics of changes in EMG indicators. In patients with type 2 diabetes mellitus, the decrease in the frequency of EMG OAM began from 10 seconds of the test, IIM – from 15 seconds, in the comparison group – from 5 and 10 seconds, respectively. The OAM EMG amplitude in the main group did not change significantly, in the comparison group it increased from 5 seconds of expiratory effort. At the 10th second of the test, the amplitude index of the EMG OAM in patients with type 2 diabetes mellitus was 10.4% lower (p=0.027) than in the comparison group, and at the 15th second – by 10.5% (p=0.033). Conclusion: The change in the electrical activity of the expiratory muscles in patients with type 2 diabetes mellitus is due to the slowed down dynamics of the frequency-amplitude characteristics of the EMG OAM, uncompensated IIM fatigue, as well as lower values of the OAM EMG amplitude when performing a functional exercise test with a static expiratory effort.

Evaluation of the Pulmonary Function Test (PFT) in Patients Affected by Severe COVID-19 Pneumonia: 6 to 12 Weeks After Discharge

The most lethal adverse effect of COVID-19 is acute respiratory distress syndrome, which can lead to rapid death. This symptom even causes concern for patients who have recovered and have been discharged. Therefore, it is obligatory to test and monitor variations in their lungs’ function after recovery. In this study, we evaluated the pulmonary function of 64 patients with severe COVID-19, six weeks to 3 months after discharge. Pulmonary function parameters were measured by spirometry and body box according to the criteria of the American Thoracic Society and under the supervision of an adult pulmonologist. According to the forced expiratory volume (FEV1)/forced vital capacity (FVC) ratio and total lung capacity (TLC) values, it was found that 3.1% of people had an obstructive pattern, 40.63% of patients had the restrictive pattern, and 6.25% of improved individuals showed a mixed pattern. Furthermore, the study of diffusion capacity of carbon monoxide (DLCO) index revealed that 13.3%, 25%, and 53% of cases had mild, moderate, and severe disorders of gas exchange, respectively. In addition, determining the maximum amount of inspiratory muscles (PI max) and expiratory muscles (PE max) disclosed that the rate of these two indicators in 62.5% and 71.88% of the subjects were less than 50%, respectively. In general, the results of the present study suggest that pulmonary function test and follow-up of patients' condition are not only recommended but seems to be essential after recovery due to the large percentage of patients with the restricted pattern a few weeks after recovery.

Point-of-Care Respiratory Muscle Ultrasound in a Child with Medical Complexity

Point-of-care ultrasound of the diaphragm is a simple, noninvasive, dynamic bedside evaluation of diaphragm function that involves no ionizing radiation, does not require patient transport, and enables the serial evaluation of diaphragmatic function over time. Adverse effects on the diaphragm attributed to ventilator-induced diaphragm dysfunction include longer weaning times, ventilation time and weaning failure. Recent investigations of point-of-care ultrasound evaluating the expiratory muscles of the lateral abdominal wall have found similar adverse effects of mechanical ventilation on these important respiratory muscles resulting in weaning difficulty as well as impaired airway clearance. Children with medical complexity have significant chronic health conditions that may involve multisystem disease (congenital or acquired), high medical fragility, functional and psychosocial impairment, technology dependence (tracheostomies, mechanical ventilation, feeding tubes) and high resource utilization (frequent and/or prolonged hospitalizations). Weaning children dependent on mechanical ventilation is a common rehabilitation goal that has beneficial effects on the quality of life, ease of care, and functionality for transitioning to home care. We present a case of weaning difficulty in a child with medical complexity and the important role of point-of-care ultrasound in the evaluation of the diaphragm and expiratory muscles during a spontaneous breathing trial.

Handgrip Force and Maximum Inspiratory and Expiratory Pressures in Critically Ill Patients With a Tracheostomy

Background The association between peripheral striated muscle strength and respiratory muscle strength has been confirmed in a number of disorders. However, this association is unknown in intensive care unit patients with tracheostomies. Objective To examine correlations between handgrip force, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) in intensive care unit patients with tracheostomies. Methods Twenty patients (7 women, 13 men) with tracheostomies, in the intensive care unit longer than 11 days, in stable condition, with functional limbs, and with Glasgow Coma Scale scores of 15 were recruited. Both MIP and MEP were measured with a membrane manometer; handgrip force was measured with a hydraulic hand dynamometer. Results Handgrip force was significantly correlated with MIP (r = 0.45, P = .04) and MEP (r = 0.78, P = .001). Handgrip force was significantly predicted by MIP and MEP when the effect of sex was controlled for (P < .05). However, when MIP and MEP were included as predictors in a regression model, MEP was the only significant predictor (R = 0.80, R2 = 0.63, adjusted R2 = 0.57). Conclusions Strength of the hand flexors and strength of the expiratory muscles (abdominal) were significantly correlated in intensive care unit patients. Handgrip strength appears to be an easy, fast way to evaluate expiratory muscle strength by using a simple handhold command without special equipment. A strong handhold may also correspond to strong expiratory muscles. ClinicalTrials.gov: NCT03457376