The Effects of Early Rehabilitation and Diaphragm Kinesiotaping on Diaphragm Muscle Thickness in Patients with Severe COVID-19 Pneumonia in the Intensive Care Unit

Year 2023, Volume: 5 Issue: 3, 199 - 208, 29.07.2023

Sinem Akselim , Taner Dandinoğlu , Serra Topal , Gülbahar Çalışkan

https://doi.org/10.46310/tjim.1279770

Abstract

Objective The efficacy of early rehabilitation in patients in the intensive care unit is apparent. However, it is still unclear in COVID-19 patients. Also, the effects of diaphragm kinesiotaping on outcomes and muscle thickness were not shown previously. Thus, we aimed to investigate the efficacy of rehabilitation and diaphragm kinesiotaping in patients with severe COVID-19 pneumonia by evaluating with the ultrasonography of the diaphragm.
Methods Patients with severe COVID-19 pneumonia in intensive care unit requiring high flow oxygen therapy included in the study. Patients with severe COVID-19 pneumonia in intensive care unit requiring high flow oxygen therapy were divided into three groups: Group 1 (n = 22) rehabilitation, group 2 (n = 26) rehabilitation and diaphragm kinesiotaping, Group 3 (n = 24) control group-only standard intensive care unit care. Ultrasonographic measurements of diaphragm thickness and thickening fraction were recorded repeatedly.
Results The demographic characteristics, mortality, and length of stay were not different between groups. However, invasive mechanic ventilation requirement and the decrease in diaphragm thickness and thickening fraction values were significantly lower in the diaphragm kinesiotaping group. Baseline diaphragm thickness and thickening fraction values were found to impact invasive mechanic ventilation requirement. Cut-off values for these parameters are 2.85 mm and 37.95%, respectively.
Conclusion Baseline diaphragm thickness can be used to predict noninvasive ventilation failure. By the way, the patients who are more likely to develop respiratory failure should receive inspiratory muscle training exercises combined with general rehabilitation principles. Also, diaphragm kinesiotaping should be included in the rehabilitation protocol.

Keywords

COVID-19, intensive care unit, rehabilitation, diaphragm kinesiotape, diaphragm thickness, diaphragmatic thickening fraction

References

• Coronavirus Disease 2019 (COVID-19) Technical Guidance. Available at: https://www.who.int/health-topics/coronavirus#tab=tab_1. Accessed May 15, 2020.
• Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-62. doi: 10.1016/S0140-6736(20)30566-3.
• Qin ES, Hough CL, Andrews J, Bunnell AE. Intensive care unit-acquired weakness and the COVID-19 pandemic: A clinical review. PM R. 2022 Feb;14(2):227-38. doi: 10.1002/pmrj.12757.
• Masiero S, Zampieri D, Del Felice A. The place of early rehabilitation in ıntensive care unit for COVID-19. Am J Phys Med Rehabil. 2020 Aug;99(8):677-8. doi: 10.1097/PHM.0000000000001478.
• Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther. 2012 Dec;92(12):1524-35. doi: 10.2522/ptj.20110406.
• Wang TJ, Chau B, Lui M, Lam GT, Lin N, Humbert S. Physical Medicine and Rehabilitation and Pulmonary Rehabilitation for COVID-19. Am J Phys Med Rehabil. 2020 Sep;99(9):769-74. doi: 10.1097/PHM.0000000000001505.
• Yang F, Liu N, Hu JY, Wu LL, Su GS, Zhong NS, et al. [Pulmonary rehabilitation guidelines in the principle of 4S for patients infected with 2019 novel coronavirus (2019-nCoV)]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):180-2 (in Chinese). doi: 10.3760/cma.j.issn.1001-0939.2020.03.007.
• Ozyemisci Taskiran O, Turan Z, Tekin S, Senturk E, Topaloglu M, Yurdakul F, Ergonul O, Cakar N. Physical rehabilitation in Intensive Care Unit in acute respiratory distress syndrome patients with COVID-19. Eur J Phys Rehabil Med. 2021 Jun;57(3):434-42. doi: 10.23736/S1973-9087.21.06551-5.
• Zambon M, Greco M, Bocchino S, Cabrini L, Beccaria PF, Zangrillo A. Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review. Intensive Care Med. 2017 Jan;43(1):29-38. doi: 10.1007/s00134-016-4524-z.
• Severin R, Arena R, Lavie CJ, Bond S, Phillips SA. Respiratory muscle performance screening for ınfectious disease management following COVID-19: A highly pressurized situation. Am J Med. 2020 Sep;133(9):1025-32. doi: 10.1016/j.amjmed.2020.04.003.
• Kurtaiş Aytür Y, Köseoğlu BF, Özyemişçi Taşkıran Ö, Ordu-Gökkaya NK, Ünsal Delialioğlu S, Sonel Tur B, Sarıkaya S, Şirzai H, Tekdemir Tiftik T, Alemdaroğlu E, Ayhan FF, Duyur Çakıt BD, Genç A, Gündoğdu İ, Güzel R, Demirbağ Karayel D, Bilir Kaya B, Öken Ö, Özdemir H, Soyupek F, Tıkız C. Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation. Turk J Phys Med Rehabil. 2020 May 12;66(2):104-20. doi: 10.5606/tftrd.2020.6444.
• Kase K, Wallis J, Kase T. Clinical Therapeutic Applications of the Kinesio Taping® Method. 2nd ed. Tokyo: Ken Ikai Co Ltd; 2003.
• Celiker R, Guven Z, Aydog T, Bagis S, Atalay A, Caglar Yagci H, Korkmaz N. The Kinesiologic Taping Technique and its Applications. Turk J Phys Med Rehabil. 2011;57(4):225-35. doi: 10.4274/tftr.46548
• Aydoğan Arslan S, Daşkapan A, Özünlü Pekyavaş N, Sakızlı E. Effects of kinesio taping applied to diaphragm muscle on aerobic exercise capacity and pulmonary function in sedentary individuals. Anatol Clin. 2018;23(2):68-72. doi: 10.21673/anadoluklin.385414.
• Ökmen MB, Ökmen K. Effectiveness of kinesiotaping on diaphragm thickness, diaphragmatic thickening fraction, and intercostal muscle thickness in patients undergoing mechanical ventilation: a pilot study. Eur Res J. 2019;5(1):68-76. doi: 10.18621/eurj.373465.
• Goligher EC, Laghi F, Detsky ME, Farias P, Murray A, Brace D, Brochard LJ, Bolz SS, Rubenfeld GD, Kavanagh BP, Ferguson ND. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med. 2015 Apr;41(4):734. doi: 10.1007/s00134-015-3724-2.
• Sosnowski K, Lin F, Mitchell ML, White H. Early rehabilitation in the intensive care unit: an integrative literature review. Aust Crit Care. 2015 Nov;28(4):216-25. doi: 10.1016/j.aucc.2015.05.002.
• Chinese Association of Rehabilitation Medicine; Respiratory Rehabilitation Committee of Chinese Association of Rehabilitation Medicine; Cardiopulmonary Rehabilitation Group of Chinese Society of Physical Medicine and Rehabilitation. [Recommendations for respiratory rehabilitation of coronavirus disease 2019 in adult]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Apr 12;43(4):308-14 (in Chinese). doi: 10.3760/cma.j.cn112147-20200228-00206.
• Li L, Yu P, Yang M, Xie W, Huang L, He C, Gosselink R, Wei Q, Jones AYM. Physical therapist management of COVID-19 in the Intensive Care Unit: The West China Hospital Experience. Phys Ther. 2021 Jan 4;101(1):pzaa198. doi: 10.1093/ptj/pzaa198.
• Tomruk M, Keleş E, Özalevli S, Alpaydin AÖ. Effects of thoracic kinesio taping on pulmonary functions, respiratory muscle strength and functional capacity in patients with chronic obstructive pulmonary disease: A randomized controlled trial. Explore (NY). 2020 Sep-Oct;16(5):332-8. doi: 10.1016/j.explore.2019.08.018.
• Thelen MD, Dauber JA, Stoneman PD. The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial. J Orthop Sports Phys Ther. 2008 Jul;38(7):389-95. doi: 10.2519/jospt.2008.2791.
• Jaraczewska E, Long C. Kinesio taping in stroke: improving functional use of the upper extremity in hemiplegia. Top Stroke Rehabil. 2006 Summer;13(3):31-42. doi: 10.1310/33KA-XYE3-QWJB-WGT6.
• Visser LH. Critical illness polyneuropathy and myopathy: clinical features, risk factors and prognosis. Eur J Neurol. 2006 Nov;13(11):1203-12. doi: 10.1111/j.1468-1331.2006.01498.x.
• Sklar MC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, Rittayamai N, Harhay MO, Reid WD, Tomlinson G, Rozenberg D, McClelland W, Riegler S, Slutsky AS, Brochard L, Ferguson ND, Goligher EC. Association of low baseline diaphragm muscle mass with prolonged mechanical ventilation and mortality among critically Ill adults. JAMA Netw Open. 2020 Feb 5;3(2):e1921520. doi: 10.1001/jamanetworkopen.2019.21520.
• Demoule A, Jung B, Prodanovic H, Molinari N, Chanques G, Coirault C, Matecki S, Duguet A, Similowski T, Jaber S. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact-a prospective study. Am J Respir Crit Care Med. 2013 Jul 15;188(2):213-9. doi: 10.1164/rccm.201209-1668OC.
• Adler D, Dupuis-Lozeron E, Richard JC, Janssens JP, Brochard L. Does inspiratory muscle dysfunction predict readmission after intensive care unit discharge? Am J Respir Crit Care Med. 2014 Aug 1;190(3):347-50. doi: 10.1164/rccm.201404-0655LE.
• Nakanishi N, Oto J, Ueno Y, Nakataki E, Itagaki T, Nishimura M. Change in diaphragm and intercostal muscle thickness in mechanically ventilated patients: a prospective observational ultrasonography study. J Intensive Care. 2019 Dec 2;7:56. doi: 10.1186/s40560-019-0410-4.
• Marchioni A, Castaniere I, Tonelli R, Fantini R, Fontana M, Tabbì L, Viani A, Giaroni F, Ruggieri V, Cerri S, Clini E. Ultrasound-assessed diaphragmatic impairment is a predictor of outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease undergoing noninvasive ventilation. Crit Care. 2018 Apr 27;22(1):109. doi: 10.1186/s13054-018-2033-x.
• van Steveninck AL, Imming LM. Diaphragm dysfunction prior to intubation in a patient with Covid-19 pneumonia; assessment by point of care ultrasound and potential implications for patient monitoring. Respir Med Case Rep. 2020;31:101284. doi: 10.1016/j.rmcr.2020.101284.
• Corradi F, Vetrugno L, Orso D, Bove T, Schreiber A, Boero E, Santori G, Isirdi A, Barbieri G, Forfori F. Diaphragmatic thickening fraction as a potential predictor of response to continuous positive airway pressure ventilation in Covid-19 pneumonia: A single-center pilot study. Respir Physiol Neurobiol. 2021 Feb;284:103585. doi: 10.1016/j.resp.2020.103585.