Thesis (M.Sc.) - Cairo University - Faculty of Physical Therapy - Department of Physical Therapy for Cardiopulmonary and Geriatrics Disorder

Background: Unloading the diaphragm by mechanical ventilation results in damage, thinning and atrophy of the diaphragm; a condition that is recognized as ventilator-induced diaphragmatic dysfunction (VIDD). This consequently leads to prolonged ventilation, extubation failure and higher risk of mortality.The purpose of the study: was to investigate the effect of inspiratory muscle training protocol that includes titrated loads on the diaphragm in order to prevent or reverse diaphragmatic atrophy as a part of an early rehabilitation programme. Subject and Methods: Fifty-five patients of both genders, aged between 30 and 45 years, intubated and mechanically ventilated as a result of with type (I) hypoxic respiratory failure due to COVID-19 were randomly collected from ICU units of Kasr El-Ainy and Imbaba Fever Hospitals. The patients were assigned into study (14 females and 18 males) and control (9 females and 14 males) groups, the first group received inspiratory muscle training in addition to the routine chest physiotherapy, while the second group received routine chest physiotherapy only. Diaphragmatic thickness of both groups was measured using ultrasonography on the 1st and 3rd day of mechanical ventilation.Then, intra-group and inter-group comparisons were performed. Results: The diaphragmatic thickness at the end of inspiration and expiration significantly increased in the study group that received inspiratory muscle training (p<0.05) while there was a non-significant increase in diaphragmatic thickness fraction for this group (p>0.05)

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