A Randomized Controlled Trial of The Diaphragmatic Manual Therapy on Respiratory and Cardiovascular Functions in Severe Pneumonia Patients

Background: Pneumonia is the leading cause of ICU admissions and a common secondary infection in critically ill patients, often leading to septic shock and requiring respiratory support. The role of diaphragmatic and right ventricular (RV) function evaluation in pneumonia prognosis is not well understood. Diaphragmatic manual therapy, including diaphragmatic stretch and manual diaphragm release, aims to improve respiratory function by enhancing diaphragm mobility and flexibility. Methods: This randomized controlled trial included hospitalized adults with severe pneumonia at Tanta Faculty of Medicine, Beni-Suef Faculty of Medicine, and Zhraa Hospital, Faculty of Medicine for Girls. Participants were randomly assigned to a control group receiving standard medical treatment or an interventional group receiving additional diaphragmatic manual therapy. The interventional group was further divided into two subgroups: one receiving the diaphragmatic stretch technique (DST) and the other the manual diaphragm release technique (MDST). Diaphragmatic excursion (Dex), RV and pulmonary functions were evaluated using ultrasonography and echocardiography before and after the interventions. Results: Thirty cases were included, with ten patients in each group. There were significant improvements in pulmonary function tests (FEV1/FVC), arterial blood gases, and diaphragmatic mobility in the interventional groups compared to the control group. Both DST and MDST showed significant improvements in diaphragmatic excursion and RV functions. However, there were no significant differences between the two techniques. Conclusion: Both DST and MDST can be safely recommended for patients with severe pneumonia to improve diaphragmatic excursion, chest expansion, and RV functions. These findings suggest that diaphragmatic manual therapy could be an effective adjunctive treatment in the management of severe pneumonia, warranting further research to explore its long-term benefits and applications.