Kandel Dipendra, Knulst Arjan J, Riggsbee Joshua, Riggsbee Sarah O, Tamang Suman, Bhattarai Himal Bikram, Karn Mitesh
International Nepal Fellowship-Nepal Green Pastures Hospital and Rehabilitation Center, Pokhara, Nepal.
Department of Biomechanical Engineering Delft University of Technology, Delft, Netherlands.
Case Rep Med. 2024 Sep 2;2024:8877421. doi: 10.1155/2024/8877421. eCollection 2024.
. This article details the development and use of a low-cost, custom RMST device for a patient with long COVID who had received positive airway flow support during ICU treatment. By sharing our successful management of respiratory muscle weakness in a severe COVID-19 patient, we aim to contribute to the broader conversation around effective long COVID management. . A patient with respiratory muscle weakness used a hospital-made RMST device. The training involved ten short forced exhalations per cycle for five cycles, followed by five long forced exhalations held for five seconds. Additionally, the patient learned lower abdominal and box breathing techniques. The patient showed significant improvement, using the RMST device without supplemental oxygen within 24 hours and completely weaned off by day 5. By discharge, the patient could complete the RMST exercise regime and achieved 290 meters in the 6MWT. After six weeks of outpatient therapy, the patient used the RMST device at 80 cm HO and increased their 6MWT distance to 390 meters. . The RMST device was designed for in-house production with a 3D-printed PETG cap, base, and plunger, and a standard pen spring. Its design mimicked a standard PEEP valve with a different geometry. The spring closed the valve until a pressure threshold was reached, allowing airflow. The adjustable pressure threshold ranged from -40 to +40 cm HO, calibrated in 10 cm HO increments by measuring displaced water column height. . COVID-19 can cause long-term respiratory issues needing proper management and rehabilitation. Inspiratory muscle training benefits those recovering from severe COVID-19 who were weaned from mechanical ventilation. However, the device's design and production method are unsuitable for large-scale and commercial production. Rehabilitation centers should prepare for postintensive care syndrome in post-COVID-19 individuals, with interprofessional teams addressing various recovery aspects. Early medical attention and therapy can improve patients' quality of life.
本文详细介绍了一种低成本的定制化呼吸肌力量训练(RMST)设备的开发与使用,该设备用于一名在重症监护病房(ICU)治疗期间接受过气道正压支持的新冠后患者。通过分享我们对一名重症新冠患者呼吸肌无力的成功管理经验,我们旨在为更广泛的关于有效管理新冠后遗症的讨论做出贡献。
一名呼吸肌无力患者使用了医院自制的RMST设备。训练包括每个周期进行10次短时间用力呼气,共5个周期,随后进行5次持续5秒的长时间用力呼气。此外,患者还学习了下腹部呼吸和腹式呼吸技巧。患者有显著改善,在24小时内无需补充氧气即可使用RMST设备,并在第5天完全脱机。出院时,患者能够完成RMST训练方案,并在6分钟步行试验(6MWT)中达到290米。门诊治疗六周后,患者在80厘米水柱(cm HO)压力下使用RMST设备,并将其6MWT距离增加到390米。
RMST设备设计为可内部生产,其部件包括3D打印的聚对苯二甲酸乙二酯二醇酯(PETG)帽、底座和活塞,以及一个标准笔弹簧。其设计模仿了具有不同几何形状的标准呼气末正压(PEEP)阀。弹簧关闭阀门,直到达到压力阈值,此时允许气流通过。可调压力阈值范围为-40至+40 cm HO,通过测量水柱位移高度以10 cm HO为增量进行校准。
新冠病毒(COVID-19)可导致长期呼吸问题,需要适当管理和康复。吸气肌训练对从机械通气撤机的重症新冠康复患者有益。然而,该设备的设计和生产方法不适合大规模商业生产。康复中心应为新冠后个体的重症监护后综合征做好准备,由跨专业团队处理各个恢复方面的问题。早期医疗关注和治疗可改善患者生活质量。