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Physiotherapy management for COVID-19

Physiotherapists who work in primary healthcare facilities are likely to have a role in the management of patients admitted to hospital with confirmed or suspected COVID-19. Physiotherapy is an established profession. Globally, some physiotherapy specialists who work in acute hospital wards and ICUs. In particular, cardiorespiratory physiotherapists focuses on the management of acute and chronic respiratory conditions and aims to improve physical recovery following an acute illness. Physiotherapy may be beneficial in the respiratory treatment and physical rehabilitation of patients with COVID-19. Although a productive cough is a less common symptom (34%), physiotherapy may be indicated if patients with COVID-19 present with copious airway secretions that they are unable to clear independently which can reduce the need for mechanical ventilation and reduce the duration resulting in more favorable outcomes for patients.

_COVID 19 stages of illness..

Stage A: patients who are ventilated, critically ill, sedated and

Paralyzed. In this stage patients may develop pneumonia characterized by bilateral interstitial infiltrates, with severe hypoxic respiratory failure (ARDS – Acute Respiratory Distress Syndrome) .

The main goal of Physiotherapy intervention at this stage is:

 

·       Facilitating oxygenation through combination of positioning and suction.

- placing the sickest ventilated coronavirus patients on their stomachs -- called prone ventilation  positioning - helps increase the amount of oxygen that's getting to their lungs by:

    +opening collapsed alveoli

    +Reduced lung compression — Lung compression by both the heart and the diaphragm can be favorably affected by prone positioning.

     +increasing in cardiac output.

 

Stage B: patients who are Ventilated-minimally sedated/ on sedation vacation.

The main goals of Physiotherapy interventions intervention at this stage are:

·       Mobilizing secretions and ease the work of breathing. Through such techniques as positioning, autogenic drainage, deep breathing exercises, breath stacking, active cycle of breathing mobilization and manual techniques (e.g. percussion, vibrations, assisted cough) to aid sputum expectoration.

·       To minimize the complications of the prolonged recumbent position through active and active assistant exercises.

 

Stage C: Non- mechanically ventilated patients.

After performing a physiotherapeutic examination assessing e.g. the condition of the respiratory system, the physiotherapist should determine the therapeutic problems in the patient's treatment process based on clinical conclusions. The main goals of Physiotherapy interventions are:

·       reducing the symptoms of dyspnea ” shortness of breath”

·       To improve lung capacity

·       general fitness exercises, preventing the effects of immobilization and increasing physical activity tolerance.

 

? stable dyspnea symptoms within mild level (2 points on the VAS scale) is an important sign for patient discharging after his test twice negative results.

-References:

            http://www.apta.org/COVID-19/PhysicalTherapySupport

 

            Respiratory physiotherapy in patients with COVID-19 infection in acute setting https://www.ncbi.nlm.nih.gov/pubmed/32236089

·       Acute Care Physiotherapy Management of COVID-19 Patients in Qatar: Consensus-Based Recommendations file:///C:/Users/peter/Downloads/preprints202004.0417.v1.pdf

·       Prone ventilation for adult patients with acute respiratory distress syndrome

https://www.uptodate.com/contents/prone-ventilation-for-adult-patients-with-acute-respiratory-distress-syndrome?topicRef=1653&source=see_link&fbclid=IwAR0RdIYnXjzMyh3r1X6GA6rUg7Yi9YLlwDt5vLJcjnXLxUKoSWh_RopU5T4

·        

https://physio-pedia.com/Role_of_the_Physiotherapist_in_COVID-19

·       Recommendations for physiotherapy of adult patients with COVID-19

https://www.wcpt.org/sites/wcpt.org/files/files/wcptnews/images/Recommendations%20for%20physiotherapy%20of%20adult%20patients%20with%20COVID-19_POLISH.pdf
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