Respiratory Muscle Performance Screening for Infectious Disease Management Following COVID-19: A Highly Pressurized Situation

Severin, Richard; Arena, Ross; Lavie, Carl J; Bond, Samantha; Phillips, Shane A.

Abstract The 2019-2020 coronavirus pandemic elucidated how a single highly infectious virus can overburden healthcare systems of even highly economically developed nations. A leading contributor to these concerning outcomes is a lack of available intensive care unit (intensive care unit) beds and mechanical ventilation support. Poorer health is associated with a higher risk for severe respiratory complications from the coronavirus. We hypothesize that impaired respiratory muscle performance is an underappreciated factor contributing to poor outcomes unfolding during the coronavirus pandemic. While impaired respiratory muscle performance is considered to be rare, it is more frequently encountered in patients with poorer health, in particular obesity. However, measures of respiratory muscle performance are not routinely performed in clinical practice, including those with symptoms such as dyspnea. The purpose of this perspective paper is to discuss the potential role of respiratory muscle performance from the perspective of the coronavirus pandemic. We also provide a theoretical patient management model to screen for impaired respiratory muscle performance and intervene if identified with the goal of unburdening healthcare systems during future pandemic crises. • Poor baseline health increases the risk of acute respiratory distress syndrome due to coronavirus infection and poorer outcomes. • Patients with poorer baseline health, notably obesity, are more likely to demonstrate impaired respiratory muscle performance, and poorer outcomes following intensive care unit admission and mechanical ventilation. • This relationship indicates respiratory muscle performance may contribute to outcomes related to acute respiratory distress syndrome from coronavirus infection in patients with poor baseline health.