Respiratory Strength Testing and Training in Adults with Severe Burns: Exploring the Feasibility of a Testing and Treatment Protocol for patients with Inspiratory Weakness

Vincent Costanzo^1,2, Nicola Clayton^2,3,4, Robert Amery¹, Kate Ryan¹, Frank Li^1,2, Mark Kol³, Peter Maitz^2,5,
¹Physiotherapy Department – Concord Repatriation General Hospital, Sydney, NSW , Australia
²Burns Unit – Concord Repatriation General Hospital, Sydney , NSW , Australia
³Intensive Care Unit – Concord Repatriation General Hospital, Sydney, NSW, Australia
⁴School of Health and Rehabilitation Sciences – University of Queensland QLD, Australia
⁵Faculty of Medical and Health Sciences – University of Sydney NSW, Australia

Abstract

Background: Respiratory muscle strength testing is a method used to quantify pulmonary function, identify inspiratory/expiratory weakness and subsequently guide intervention. Evidence suggests that low Maximal-Inspiratory-Pressures (MIP) increases the risk of pulmonary complications in hospitalised populations. Inspiratory Muscle Training (IMT) is a low cost, effective way to improve pulmonary function and minimise respiratory sequalae. However, respiratory testing/training has not been routinely performed in severe burns.

Aim: To explore the feasibility and safety of an inpatient respiratory muscle testing and training protocol, targeting the early detection and retraining of inspiratory muscle strength in severe burns.

Methods: A non-randomized feasibility study was conducted over 3-months at Concord Burns Unit. Eligible participants underwent strength testing of MIP with a goal to test within 72-hours of admission. Those diagnosed with inspiratory weakness (MIP<60 cmH2O) proceeded to IMT. Haemodynamic monitoring (SpO2, HR, BP) was taken during training/testing with adverse events recorded. Repeat testing was performed at the cessation of training. Results: 20 participants (70%male, median age= 38.5years) were enrolled in the study. 95% were successfully tested within 72 hours of admission with nil adverse events or haemodynamic compromise recorded. Two patients exhibited inspiratory muscle weakness and proceeded to IMT at 50%MIP training load until discharge. The IMT protocol was performed daily without complication, with an improvement in MIP (18cmH2O and 15cmH2O respectively) evident in both subjects on repeat testing. Conclusion: Respiratory muscle testing and training is and safe, feasible and should be considered as a potential rehabilitative adjunct to improve pulmonary function in burn injury.

Biography

Vincent Costanzo is a Physiotherapist working in the Burns Unit at Concord Repatriation General Hospital (NSW, Australia). With senior clinical experience across a range of inpatient services (including Burns, Intensive Care and Plastics), his interests involve respiratory management and the rehabilitation of burns and inhalation injuries.