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Thoracic Pump as Adjunctive Therapy to Wean Oxygen Supplementation in the Hospitalized COVID 19 Patient
Rhoads, A. [3]
Baig, Z. [1]
Sterling, Z. [1]

Journal: Journal of Osteopathic Medicine Date: 2022/12, 122(12):Pages: A41-A42. doi: Subito , type of study: retrospective study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2022-2000/html)

Keywords:

covid-19 [76]
pneumonia [35]
retrospective study [213]
thoracic pump technique [4]

Abstract:

Statement of Significance: Viral pneumonia is the main outcome of COVID 19 infection that results in inflammatory changes to the lung parenchyma. Potential for OMT as an adjuvant therapy for COVID pneumonia has been speculated by individuals studying COVID’s pathophysiology as research supports benefits of OMT in bacterial pneumonia. Literature suggests OMT, improves respiratory function, reduces length of stay and mortality in the hospital, when OMT was used with conventional therapy for treatment of pneumonia. Research Methods: This study is a retrospective chart review of patients admitted to the hospital with a diagnosis of COVID 19 treated with OMT by a DO attending. We identified four patients in this study that met the inclusion criteria. Inclusion criteria included age greater than 18, admitted to the hospital with the diagnosis of acute COVID 19, on moderate pathway for treatment requiring at least 2 litters of oxygen supplementation, and receiving thoracic pump technique within 48 hours of expected discharge. Exclusion criteria included: treatment for co-infection with bacterial pneumonia, requiring high flow nasal cannula, non-invasive positive pressure or mechanical ventilation. Osteopathic Manipulative Treatment included Thoracic pump with respiratory assist technique to the lower and upper rib cage bilaterally, specifically ribs 2-4 and 7-9 respectively. The technique is performed by physician placing hands on ribs 2-4 or 7-9, and then instructing the patient to inhale and exhale deeply. The Physician provides a compressive force downward onto the chest wall. Then, oscillate the degree of compression to produce a pump motion during exhalation. This is repeated for three breathing cycles. Oxygen saturations were recorded prior to treatment and within five minutes of treatment for post-treatment values and then at the time of discharge. Statistical analysis was conducted in IBM SPSS for Windows Version 26. Due to small sample size, only descriptive statistics were included for median oxygen saturation before OMT, five minutes post-OMT and at time of discharge. The osteopathic significance of this study is to demonstrate OMT as an adjunctive therapy to be considered for hospitalized COVID 19 patients, as previous literature supports efficacy of OMT in hospitalized pneumonia and influenza patients. Data Analysis/Results: After review of inclusion criteria, four subjects met criteria of admission for COVID 19, on nasal cannula oxygen for acute hypoxic respiratory failure on moderate pathway for treatment of COVID 19 and received two sessions of OMT with thoracic pump within 48 hours of discharge. Ages ranged from 44-96, with a mean age of 67.75 years old. Two subjects were female and two subjects were male. Median oxygen saturation before initiating OMT as adjunctive therapy on hospitalized COVID-19 patients was 91.5%(minimum 90%, maximum 93%). After initiating thoracic pump as adjunctive therapy on hospitalized COVID-19 patients, median oxygen saturation increased to 94.5% (minimum 93% maximum 97%). There was a slight dip in median oxygen saturation when measured at the time of discharge, median 93% (minimum 93% maximum 94%.) Three out of four patients were discharged on oxygen supplementation, one patient was on chronic oxygen supplementation prior to hospitalization and was discharged at their baseline oxygen supplementation. Conclusion: In conclusion, despite a limitation in small sample size due to availability of an osteopathic attending physician, post OMT oxygen saturations were within non-hypoxic ranges directly following treatment with five minutes of performing thoracic pump technique. Larger randomized control studies would be needed to demonstrate statistically significant improvement in oxygen saturations with thoracic pump treatment compared to standard of care. However, this chart review demonstrates a change in oxygen saturations post treatment to non-hypoxic levels. Literature suggests that techniques targeting lymphatic flow, including thoracic pump, are advantageous for treatment of pneumonia by improving respiratory function, enhancing antibody response, decreasing hospital length of stay, and increasing the abundance of white blood cells in peripheral blood. Therefore, thoracic pump technique should be considered as an adjunctive therapy for hospitalized COVID 19 patients and should be utilized as early as possible into hospital admission to decrease respiratory complications and need for oxygen supplementation from COVID 19 infection.

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