Article

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. CASE DESCRIPTION: 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.
Five months later, he
continued to describe severe dyspnea on exertion. During a cardiopulmonary
exercise test on a cycle ergometer, he achieved a maximum rate of oxygen uptake
of 2,898 mL.min(-1) (114% predicted) and maximum power of 230 W (114% predicted).
His maximum forced inspiratory flow was 5.95 L.s(-1), and inspiratory reserve
volume at test end was approximately 80 mL. The test was terminated by the
patient due to dyspnea that was too severe to tolerate. Video fluoroscopy
demonstrated impaired right hemidiaphragm function. 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. OUTCOMES: An average of 5 sessions of IMT were completed
each week for 10 weeks. During a repeat cardiopulmonary exercise test, the
patient achieved a similar power and maximum rate of oxygen uptake. His maximum
forced inspiratory flow increased by 48% to 8.83 L.s(-1),
and he was limited by leg fatigue. DISCUSSION: High-intensity IMT was safe and well tolerated. It was
associated with improvements in maximum forced inspiratory flow and changed the
locus of symptom limitation during high-intensity exercise from dyspnea to leg fatigue.

Langue : ANGLAIS