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Extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are now widely recognized and have important clinical implications.1,2 To our knowledge, the association of SARS-CoV-2 with the respiratory muscles has not been studied. This is surprising, as the respiratory muscles drive alveolar ventilation and their weakness results in acute respiratory failure. In critically ill patients undergoing ventilation, respiratory muscle weakness prolongs mechanical ventilation and increases mortality.3 The aim of this study was to investigate the association of severe coronavirus disease 2019 (COVID-19) with the respiratory muscles in critically ill patients and compare the findings with those obtained from non-COVID-19 critically ill patients.
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Accepted for Publication: September 10, 2020.
Published Online: November 16, 2020. doi:10.1001/jamainternmed.2020.6278
Corresponding Author: Coen Ottenheijm, PhD, Department of Physiology, Amsterdam UMC, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands (firstname.lastname@example.org).
Author Contributions: Dr Ottenheijm had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Shi, Boon, Heunks, Ottenheijm.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Shi, Heunks, Ottenheijm.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Shi, de Vries, Ottenheijm.
Obtained funding: Ottenheijm.
Administrative, technical, or material support: de Vries, Heunks, Ottenheijm.
Supervision: Vlaar, Boon, Heunks, Ottenheijm.
Conflict of Interest Disclosures: Dr de Vries reported grants from Amsterdam Cardiovascular Sciences during the conduct of the study and personal fees from a Dutch ultrasound center outside the submitted work. Dr Heunks reported personal fees from Getinge and grants from Liberate Medical outside the submitted work. No other disclosures were reported.
Dutch COVID-19 Diaphragm Investigators: Bernadette Schurink, MD, PhD, Eva Roos, MD, PhD, Hans W.M. Niessen, MD, PhD, Sylvia Bogaards, BSc, Stefan Conijn, BSc, Yeszamin L. Onderwater, MSc, Pedro Espinosa, MSc, Anke van Bergen, BSc, Diewertje I. Bink, MSc, Marloes van den Berg, MD (Amsterdam UMC, location VUMC),and Benno Kusters, MD, PhD (Radboudumc).
Funding/Support: The research reported in this work was supported by a grant from the National Institutes of Health/ Heart Lung and Blood Institute (R01HL121500 to Dr Ottenheijm).
Role of the Funder/Sponsor: The National Institutes of Health/ Heart Lung and Blood Institute had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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