Mr Vincent Costanzo^1,2, Dr. Nicola  Clayton^2,3,4,5, Dr.  Frank Li^1,2, Professor Peter  Maitz^2,6

¹Physiotherapy Department – Concord Repatriation General Hospital, Sydney, Australia, ²Burns Unit – Concord Repatriation General Hospital, Sydney, Australia , ³Intensive Care Unit – Concord Repatriation General Hospital, Sydney, Australia, ⁴School of Health and Rehabilitation Sciences – University of Queensland, Brisbane, Australia, ⁵Faculty of Health Sciences – University of Sydney, Sydney, Australia, ⁶Faculty of Medicine – University of Sydney, Sydney, Australia

Abstract:

Background: Respiratory dysfunction following inhalation burn injury is common, exacerbating the negative pulmonary sequelae that manifests in critical illness. Evidence suggests sustaining higher Maximal Inspiratory Pressures (Pimax) during hospitalisation can prevent Post Pulmonary Complications (PPCs). To date, rehabilitation targeting Pimax has not been explored in this cohort.

Aim: To examine the feasibility and safety of Inspiratory-Muscle-Strength-Training (IMST) in a severe burn patient with inhalation injury.

Methods: A 44-year-old male with 48%-TBSA burns with inhalation injury received treatment at Concord Burns Unit, requiring prolonged intensive care and mechanical ventilation (17-days). His admission was complicated by COVID-19 and a Klebsiella VAP. Routine respiratory physiotherapy was administered during his admission. IMST was commenced post-extubation using the EMST150 device with IA150 adapter. Pimax and haemodynamic measures (BP, HR, SpO2) were obtained prior to commencing IMST and continually monitored throughout treatment. Initial inspiratory pressures were set at 50%PiMax with a training load of 30 breaths twice daily with incremental increases of PiMax titrated to a RPE of 6-7. PPC incidence was tracked daily using the Melbourne Group Score (MGS-2).

Results: Baseline PiMax was 68cmH20 (7-days post-extubation) increasing to 105cmH20 after 21-days of treatment. IMST was well tolerated; nil adverse events were recorded and haemodynamics remained stable during therapy. Nil PPCs were diagnosed during treatment with the patient discharged home without indication for respiratory follow-up.

Conclusion: IMST was feasible and safe in this single case with burns and inhalation injury. IMST should be considered as a potential adjunct to improve pulmonary function in inhalation burn injury.

Biography:

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