{"id":61,"user_id":null,"title":"Using Respiratory Training to Assist Breathing and Swallowing in COVID-19 Patients","summary":"At Duke University Hospital, speech-language pathologists are the primary providers of RMT to strengthen the respiratory and/or upper airway muscles. We administer the therapy with devices that provide resistance against inspiration and/or expiration. There are two types of training. Expiratory muscle training (EMT) targets laryngeal vestibular closure during swallowing and enhances cough strength for airway protection. Inspiratory muscle training (IMT) targets diaphragmatic weakness that can impact speech, swallowing, and weaning from mechanical ventilation.\r\n\r\nWe measure maximum inspiratory pressure and maximum expiratory pressure, and factor in normative and individual patient data to determine candidacy for the training. Those who qualify begin a program using RMT devices with appropriate resistance levels based on their diagnosis (see sources) and assessed capabilities.","fulltext":"IMT is well-tolerated and improves inspiratory and expiratory muscle strength in critically ill patients (see sources). We initiate IMT with our patients when they have diaphragmatic weakness and difficulty weaning from the ventilator—often while they remain dependent on mechanical ventilation. We typically place the device in line with the endotracheal tube or at the tracheostomy site with the cuff inflated. As the patient progresses and we consider return to oral diet, we often add EMT to target dysphagia.\r\n\r\nBut with COVID-19, we had to reconsider our standard practice. Initially, no COVID-19 patients received RMT—out of concern for patient and staff safety—that could have been beneficial. The situation highlighted for all of us the critical role of SLPs and RMT in patients’ post-ventilation recovery. To see how others were handling RMT and COVID, we consulted the scarce literature and found early information out of China and Italy that recommended not putting stress on the respiratory system too early and limiting tasks that could increase transmission of the virus (see sources).\r\n\r\nAfter considering these recommendations and the aerosol-generating nature of the intervention, Duke’s speech pathology leadership—with input from medical and infection prevention teams—decided in September 2020 to initiate RMT with patients cleared from airborne isolation precautions (just as we don’t use RMT with other active infectious disease, such as tuberculosis). The decision to end airborne contact isolation for COVID-19 patients is based on date of onset (first positive test), illness severity, and immunocompromised status.\r\n\r\nOur medical teams were enthusiastic about resuming RMT and seeing patients benefit again, and we began IMT in critically ill COVID-19 patients cleared from airborne isolation precautions. Because they often had severe diaphragmatic weakness and overall debilitation, we began IMT with low training loads. Patients performed multiple sets daily as tolerated, interspersed with rest breaks on mechanical ventilation. We gradually increased the load until the patient demonstrated adequate strength, then added EMT when a patient was ready to resume an oral diet.\r\n\r\nWe continued RMT until patients achieved functional goals, such as return to baseline diet or decannulation. Often patients did not achieve these goals in acute care, in which case they received a home training program and outpatient follow-up.\r\n\r\n[Full Text](https://leader.pubs.asha.org/do/10.1044/leader.OTP.27052022.respiratory-muscle-training.np/full/)\r\n","category":1,"position":63,"created_at":"2025-04-19T23:48:02.359Z","updated_at":"2025-04-19T23:48:02.366Z","url":"https://www.pro2fit.com/articles/61.json"}