Inhalation muscle training after a gunshot wound safe, effective: case study
Two articles on PainSci cite Hill 2011: 1. The Respiration Connection 2. When To Worry About Shortness of Breath … and When Not To
PainSci commentary on Hill 2011: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
After a gunshot wound, a “high-intensity, interval-based threshold inspiratory muscle training (IMT) was undertaken” for the 38-year-old man. The treatment was found to be “safe and well tolerated. It was associated with improvements in maximum forced inspiratory flow and changed the locus of symptom limitation during high-intensity exercise from dyspnea to leg fatigue.”
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND AND PURPOSE: Severe injuries sustained during combat may classify individuals as undeployable for active service. It is imperative that every effort is made to optimize physical function following such injuries.
CASE DESCRIPTION: A 38-year-old man sustained a gunshot wound during armed combat. The bullet entered via the left axilla and exited from the right side of the abdomen, resulting in severe thoracic and abdominal injuries. Five months later, he continued to describe severe dyspnea on exertion. During a cardiopulmonary exercise test on a cycle ergometer, he achieved a maximum rate of oxygen uptake of 2,898 mL·min(-1) (114% predicted) and maximum power of 230 W (114% predicted). His maximum forced inspiratory flow was 5.95 L·s(-1), and inspiratory reserve volume at test end was ∼80 mL. The test was terminated by the patient due to dyspnea that was too severe to tolerate. Video fluoroscopy demonstrated impaired right hemidiaphragm function. The main goals of therapy were to reduce dyspnea on exertion and to enable return to full work duties. A program of high-intensity, interval-based threshold inspiratory muscle training (IMT) was undertaken.
OUTCOMES: An average of 5 sessions of IMT were completed each week for 10 weeks. During a repeat cardiopulmonary exercise test, the patient achieved a similar power and maximum rate of oxygen uptake. His maximum forced inspiratory flow increased by 48\% to 8.83 L·s(-1), and he was limited by leg fatigue.
DISCUSSION: High-intensity IMT was safe and well tolerated. It was associated with improvements in maximum forced inspiratory flow and changed the locus of symptom limitation during high-intensity exercise from dyspnea to leg fatigue.
related content
- “Effect of Inspiratory Muscle Training Intensities on Pulmonary Function and Work Capacity in People Who Are Healthy: A Randomized Controlled Trial,” Enright et al, Physical Therapy, 2011.
- “Inspiratory muscle training: integrative review,” Padula et al, Research & Theory For Nursing Practice, 2006.
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