Effects of High-Intensity Inspiratory Muscle Training Following a Near-Fatal Gunshot Wound

“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.”

“In this case, 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. 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.”

Conclusion:

“Given that IMT was introduced 12 months following the injury, at which point progress had reached a plateau with other rehabilitation strategies, it seems reasonable to attribute the increased maximum forced inspiratory flow recorded at rest and change in the locus of symptom limitation during exercise from the dyspnea to leg fatigue to the introduction of IMT. These data should be seen as hypothesis-generating.”

Clinical Implications and Future Research:

“The flow-volume loops recorded during the CPET allowed us to identify inefficiencies in breathing strategy and respiratory mechanics that were responsible for this patient's intolerable dyspnea during exercise. Notably, the measurement of Pimax was of no diagnostic value and was used only to prescribe the initial load for IMT. These findings suggest that static measures of the pressure-generating capacity of the inspiratory pump muscles convey little information about how they operate under dynamic conditions such as exercise. In this patient, chest fluoroscopy and the CPET with flow-volume loops provided the most useful diagnostic information. A program of high-intensity IMT should be considered for individuals who demonstrate inspiratory flows during exercise that approximate the maximum inspiratory flow recorded at rest. Further study is needed to confirm the role of IMT in people with diaphragm injury.”

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