Rik Gosselink

• PhD, PT
• Professor (Full) at KU Leuven

Background. Evidence for implementation of evidence-based protocols (EBPs) in resource-constrained intensive care units (ICUs) is sparse. Objectives. To evaluate a tailored best-practice multifaceted strategy for implementation of a validated physiotherapy EBP for the management of surgical ICU (SICU) patients. Also, to explore the physiotherapists...

Abstract Background Recent studies suggest that fast and deep inspirations against either low or high external loads may provide patients with weaning difficulties with a training stimulus during inspiratory muscle training (IMT). However, the relationship between external IMT load, reflected by changes in airway pressure swings (ΔPaw), and total i...

Assessing and treating respiratory muscle dysfunction is crucial for patients with both acute and chronic respiratory failure. Respiratory muscle dysfunction can contribute to the onset of respiratory failure and may also worsen due to interventions aimed at treatment. Evaluating respiratory muscle function is particularly valuable for diagnosing,...

Scientific Knowledge on the Subject: Weaning failure from mechanical ventilation affects up to 35% of critically ill patients and respiratory muscle dysfunction is a contributing factor. Prior studies suggest that inspiratory muscle training (IMT) can improve respiratory muscle strength (maximal inspiratory pressure; PImax) in patients with weaning...

Abstract Objectives This study investigated the feasibility and safety of interactive virtual reality rehabilitation (VRR) for patients with a critical illness and a long stay in the intensive care unit (ICU), as a motivational tool for rehabilitation. Design Single-centre, non-randomised proof-of-concept clinical trial. Participants Adult, calm,...

Background: Respiratory muscle training (RMT) aims to improve inspiratory and/or expiratory muscle function in neuromuscular disorders (NMDs). A comprehensive overview of the available literature is lacking. This scoping review explores methodological characteristics, (adverse) effects, and adherence of RMT studies in NMDs. Moreover, it identifies...

Background Several bedside assessments are used to evaluate respiratory muscle function and to predict weaning from mechanical ventilation in patients on the intensive care unit. It remains unclear which assessments perform best in predicting weaning success. The primary aim of this systematic review and meta-analysis was to summarize and compare t...

BACKGROUND. Patient satisfaction is an essential concept to consider for the improvement of quality care in healthcare centres and hospitals and has been linked to increased patient compliance with treatment plans, better patient safety and improved clinical outcomes. OBJECTIVE. As part of a before-and-after clinical trial aimed to investigate the...

Unilateral diaphragm dysfunction (UDD) is an underdiagnosed cause of dyspnea. Inspiratory muscle training (IMT) is the only conservative treatment for UDD, but the mechanisms of improvement are unknown. We characterised the effects of IMT on dyspnea, exercise tolerance, and respiratory muscle function in people with UDD. Fifteen people with UDD (73...

Background Lingering symptoms after acute COVID-19 present a major challenge to ambulatory care services. Since there are reservations regarding their optimal management, we aimed to collate all available evidence on the effects of rehabilitation treatments applicable in ambulatory care for these patients. Methods On 9 May 2022, we systematically...

Background: Physiotherapists are essential in the management of hospitalised patients. The way in which a physiotherapy service is offered in intensive care units (ICUs) can affect ICU patient outcomes. Objectives: To provide a clear picture of the organisation and structure of physiotherapy departments, the number and types of ICUs requiring ph...

Objectives: The weaning according to a new definition (WIND) classification groups mechanically ventilated (MV) patients into "short weaning," "difficult weaning," "prolonged weaning," and "no weaning." The aims of the study were 1) to describe the weaning group distribution, 2) to evaluate if "short weaning" patients can be divided into groups wi...

Background: Inspiratory muscle training (IMT) aims to improve respiratory muscle strength and endurance. Clinical trials used various training protocols, devices and respiratory measurements to check the effectiveness of this intervention. The current guidelines reported a possible advantage of IMT, particularly in people with respiratory muscle w...

Context Muscle expresses and secretes several myokines that bring about benefits in distant organs. Objective We investigated impact of critical illness on muscular expression of irisin, kynurenine-aminotransferases and amylase; association with clinical outcome; and impact of interventions that attenuate muscle wasting/weakness. Design/Setting W...

Background: Alterations in perfusion to the brain during the transition from mechanical ventilation (MV) to a spontaneous breathing trial (SBT) remain poorly understood. The aim of the study was to determine whether changes in cerebral cortex perfusion, oxygen delivery (DO2), and oxygen saturation (%StiO2) during the transition from MV to an SBT d...

Background: Respiratory muscle strength in patients with an artificial airway is commonly assessed as the maximal inspiratory pressure (MIP) and is measured using analogue or digital manometers. Recently, new electronic loading devices have been proposed to measure respiratory muscle strength. This study evaluates the agreement between the MIPs me...

We thank Fudeyasu et al. (1) for their interest in our recent article (2), published in Critical Care Medicine. The authors raise some points regarding our analyses, to which we respond below. First, they suggest that the (non-significant) 2-day difference in the time-points when patients were able to follow commands (expressed as the time of first...

Background Inspiratory muscle training improves respiratory muscle function and may improve weaning outcomes in patients with weaning difficulties. Compared to the commonly used pressure threshold loading, tapered flow resistive loading better accommodates pressure–volume relationships of the respiratory muscles, which might help to facilitate appl...

Pulmonary rehabilitation (PR) is an integral part of the management of patients with chronic respiratory diseases. However, there is limited information available on the effectiveness and practice of PR in Africa. This study was conducted to examine the prevalence, structure, and organization of PR in Africa, as well as its substance and claimed ef...

Physiotherapists are integral members of the multidisciplinary team managing critically ill adult patients. However, the scope and role of physiotherapists vary widely internationally, with physiotherapists in some countries moving away from providing early and proactive respiratory care in the intensive care unit (ICU) and focusing more on early m...

Objectives: To evaluate the impact of the additional use of early neuromuscular electrical stimulation (NMES) on an early mobilization (EM) protocol. Design: Randomized controlled trial. Setting: ICU of the Clinical Hospital of Ribeirão Preto, University of São Paulo, Brazil. Patients: One hundred and thirty-nine consecutive mechanically ven...

Objectives Evidence-based guidelines recommend physiotherapy for respiratory treatment and physical rehabilitation of patients with COVID-19. It is unclear to what extent physiotherapy services are utilised in the frontline management of COVID-19 in Nigeria. This study aimed to explore the experiences of frontline physiotherapists managing patients...

Background Long-term outcome data of COVID-19 survivors are needed to understand their recovery trajectory and additional care needs. Methods A prospective observational multi-centre cohort including adults hospitalised with COVID-19 from March through May 2020. Work-up at 3 and 12 months following admission consisted of clinical review, pulmonary...

Background Critically ill patients who have difficulties weaning from the mechanical ventilator are prone to develop respiratory muscle weakness. Inspiratory muscle training (IMT) can improve respiratory muscle strength. Whether IMT can improve scalene and sternocleidomastoid muscle oxygenation parameters is unknown. Aim To compare changes in musc...

Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey...

Physical therapy is part of the treatment for patients admitted to ICU. Proprioceptive neuromuscular facilitation (PNF) is one of the physiotherapy concepts including manual techniques and verbal stimulation. The purpose of this paper is to examine the feasibility of PNF techniques in mechanically ventilated (MV) ICU patients. Another aim is to ver...

This document provides an update to the recommendations for physiotherapy management for adults with coronavirus disease 2019 (COVID-19) in the acute hospital setting. It includes: physiotherapy workforce planning and preparation; a screening tool for determining requirement for physiotherapy; and recommendations for the use of physiotherapy treatm...

PurposeTo evaluate aerobic exercise capacity in 5-year intensive care unit (ICU) survivors and to assess the association between severity of organ failure in ICU and exercise capacity up to 5-year follow-up.Methods Secondary analysis of the EPaNIC follow-up cohort (NCT00512122) including 433 patients screened with cardiopulmonary exercise testing (...

Many patients struggle with ongoing symptoms in different domains (physical, mental, cognitive) after hospitalisation for COVID-19, calling out for a multidisciplinary approach. An outpatient multidisciplinary rehabilitation programme, according to a respiratory rehabilitation strategy, was set up for adult patients who were able to attend group se...

Background Inspiratory muscle training is safe and effective in reversing inspiratory muscle weakness and improving outcomes in patients who have experienced prolonged mechanical ventilation in the intensive care unit (ICU). The degree of worldwide implementation of inspiratory muscle training in such patients has not been investigated. Objectives...

Inspiratory muscle training (IMT) improves respiratory muscle function and might enhance weaning outcomes in patients with weaning difficulties. An electronic inspiratory loading device provides valid, automatically processed information on breathing characteristics during IMT sessions. Adherence to and quality of IMT, as reflected by work of breat...

Lifestyle-related non-communicable diseases (NCDs) and their risk factors are unequivocally associated with SARS-CoV-2 susceptibility and COVID-19 severity. NCD manifestations and their lifestyle risks are associated with chronic low-grade systemic inflammation (CLGSI). This review supports that immuno-modulation with positive lifestyle change aime...

Background Organ transplantation is a life-saving intervention that improves quality of life of patients with irreversible organ failure. Although exercise training immediately after transplantation has been suggested to be beneficial, such interventions remain rare in stable transplant recipients, whereas effects of high-intensity training (HIT) a...

As SARS-CoV-2, the virus responsible for COVID-19, spread globally, the most severely affected sub-populations were the elderly and those with multi-morbidity largely related to non-communicable diseases (NCDs), e.g., heart disease, hypertension, type 2 diabetes, obesity. NCDs are largely preventable with healthy nutrition, regular activity, and no...

Objective To retrospectively analyse data obtained from the multi-domain assessment of hospitalized COVID-19 patients, to describe their health status at discharge, and to investigate whether subgroups of patients, more specific ICU patients and older adults (> 70 years), had more (or less) risk to experience specific impairments.Methods Retrospect...

Purpose To assess the association between respiratory muscle weakness (RMW) at intensive care unit (ICU) discharge and 5-year mortality and morbidity, independent from confounders including peripheral muscle strength. Methods Secondary analysis of the prospective 5-year follow-up of the EPaNIC cohort (ClinicalTrials.gov: NCT00512122 ), limited to...

Physiotherapists are involved in the management of patients with critical illness. Physiotherapy assessment of critically ill patients is less driven by medical diagnosis; instead, there is a strong focus on deficiencies at a pathophysiological and functional level. An accurate and valid assessment of respiratory conditions (retained airway secreti...

Cardiovascular diseases (CVDs) are a major cause of premature death worldwide and a cause of loss of disability-adjusted life years. For most types of CVD early diagnosis and intervention are independent drivers of patient outcome. Clinicians must be properly trained and centres appropriately equipped in order to deal with these critically ill card...

Meer bewegen is de kern van het beleid bij COPD en verbeteren van het inspanningsvermogen is een van de belangrijkste doelstellingen. Dat geldt ook voor patiënten met lichte tot matige COPD in de huisartsenpraktijk. Een beweegprogramma blijkt inderdaad de inspanningscapaciteit enigszins te verbeteren, maar leidt niet automatisch tot actiever beweeg...

Introduction Inspiratory muscle training (IMT) protocols are typically performed using pressure threshold loading with inspirations initiated from residual volume (RV). We aimed to compare effects of three different IMT protocols on maximal inspiratory pressures (PImax) and maximal inspiratory flow (V̇Imax) at three different lung volumes. We hypot...

Purpose To investigate the effect of Neuromuscular Electrical Stimulation (NMES) on muscle thickness, strength and morphological and molecular markers of the quadriceps. Materials and methods Adult critically ill patients with an expected prolonged stay received unilateral quadriceps NMES sessions for 7 consecutive days. Before and after the inter...

Objective Coronavirus disease 2019 (COVID-19) has dominated the attention of health care systems globally since January 2020. Various health disciplines including physical therapists are still exploring the best way to manage this new disease. The role and involvement of physical therapists in the management of COVID-19 are not yet well defined and...

The study investigated whether high-intensity exercise impairs inspiratory and expiratory muscle perfusion in patients with COPD. We compared respiratory local muscle perfusion between constant-load cycling (sustained at 80% WRpeak) and voluntary normocapnic hyperpnoea reproducing similar work of breathing (WoB) in 18 patients (FEV1:58±24% predicte...

Infection with the SARS-CoV-2 virus may lead to hypoxemic respiratory failure and acute respiratory distress syndrome (ARDS). ARDS is frequently complicated by intensive care unit acquired weakness (ICUAW), which is associated with poor outcomes. Critically ill COVID-19 patients may differ from typical ARDS-patients in baseline factors and ICU expo...

BACKGROUND: Dyspnea is a commonly reported symptom during exercise in patients with unilateral diaphragmatic dysfunction (UDD) and is likely related to breathing abnormalities during exercise. OBJECTIVE: To compare breathing pattern and neuromechanical coupling during exercise hyperpnea between UDD and healthy controls (CON). METHODS: 10 UDD (ag...

Purpose The properties of a local Intensive Care Unit early mobilization protocol (‘Start To Move As Soon As Possible’) in critically ill patients, consisting of an objective diagnostic assessment linked to six treatment levels were evaluated. This study aimed to investigate whether the protocol can be reliably applied by different health-care prov...

Coronavirus disease 2019 (COVID-19) has sounded alarm bells throughout global health systems. Late May, 2020, over 100,000 COVID-19 related deaths were reported in the United State, the highest number of any country. This article describes COVID-19 as the next historical turning point in the physical therapy profession's growth and development. The...

Introduction: We aimed to compare acute mechanical and metabolic responses of the diaphragm and rib cage inspiratory muscles during two different types of respiratory loading in patients with COPD. Methods: In 16 patients (age:65±13, 56% male, FEV1:60±6%pred, Pimax:82±5%pred) assessments of respiratory muscle electromyography (EMG), esophageal (...

Background Pulmonary rehabilitation is very effective in improving exercise capacity, dyspnea and quality of life in the small group of patients with moderate to severe COPD. Given that little is known about exercise training in the large group of patients with mild to moderate COPD, we assessed the effectiveness of an exercise training programme i...

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/se...

This document outlines recommendations for physiotherapy management for COVID-19 in the acute hospital setting. It includes: recommendations for physiotherapy workforce planning and preparation; a screening tool for determining requirement for physiotherapy; and recommendations for the selection of physiotherapy treatments and personal protective e...

Respiratory muscle weakness is one modifiable factor that contributes to difficult ventilator weaning and poor long-term outcomes for intensive care unit (ICU) patients. Mechanisms of respiratory muscle weakness include atrophic changes in response to mechanical ventilation, and consequences include dyspnea, prolonged ICU stay, and higher mortality...

We compared the perception and neural processing of respiratory sensations between 20 COPD patients and 20 healthy controls by means of respiratory-related evoked potentials (RREP) in the electroencephalogram (EEG). RREPs were induced by short inspiratory occlusions while 129-channel EEG was measured. COPD patients rated the occlusions as more inte...

Purpose To assess the independent association between ICU-acquired neuromuscular complications and 5-year mortality and morbidity. To explore the optimal threshold of the Medical Research Council (MRC) sum score, assessing weakness, for the prediction of 5-year outcomes. Methods Sub-analyses of a prospective, 5-year follow-up study including 883 E...

The progress of intensive care medicine has dramatically improved survival of critically ill patients, especially in patients with acute respiratory distress syndrome (ARDS) and sepsis [1, 2]. However, this improved survival is often associated with general deconditioning, muscle weakness, prolonged mechanical ventilation, dyspnoea, depression, anx...

Introduction: In addition to the well-documented factors that contribute to weaning failure, increased energy demands of the respiratory muscles during spontaneous breathing trials (SBTs) might not be met by sufficient increases in energy supplies. This discrepancy may deprive blood and oxygen of other tissues. In this context, restrictions in per...