COVID-19 is an infectious disease caused by SARS-CoV2 virus. COVID-19 patients can develop a severe disease that can lead to hypoxic respiratory failure and acute respiratory distress syndrome (ARDS). Severe patients can require access to intensive care unit (ICU). Early rehabilitation is known to be effective in critically ill patients and in ARDS. The role of respiratory physiotherapy in critical COVID-19 patients is still unclear. The aim of this study is to describe the bundle and the timing of respiratory physiotherapy used with severe COVID-19 patients from ICU to hospital discharge. Functional condition of patients at discharge will be assessed and described.
COVID-19 is an infectious disease caused by SARS-CoV2 virus, that first appeared in China in
2019 and in Italy in February 2020.
Approximately 80% of people infected with COVID-19 have mild to moderate disease with few
symptoms, while more than 10% develop a severe disease that can lead to hypoxic respiratory
failure and acute respiratory distress syndrome (ARDS). Severe patients can require access to
intensive care unit (ICU) needing invasive mechanical ventilation (IMV) and hospitalization
for a long period.
Early rehabilitation is known to be effective in critically ill patients and in ARDS, to
reduce functional impairment due to the prolonged stay in ICU. Many works demonstrated that
early rehabilitation programs in ICU correlated with faster recovery and discharge at home of
ARDS patients and better outcomes in the walking test at discharge from the hospital.
Due to the recent development of COVID-19, few data and guidelines to menage severe COVID-19
patients are available and the role of respiratory physiotherapy is still unclear.
The aim of this study is to describe the bundle and the timing of respiratory physiotherapy
used with severe COVID-19 patients from ICU to hospital discharge. Functional condition of
patients at discharge will be assessed and described.
Other: Respiratory physiotherapy
Respiratory physiotherapy consists of:
early mobilization (passive and active mobilization, muscle-strengthening exercises, mobilization out of bed, standing, walking, ADL)
patients positioning
non-invasive mechanical ventilation / CPAP
tracheostomy management
invasive mechanical ventilation weaning
airway clearance
oxygen titration
Inclusion Criteria:
- Having laboratory confirmed COVID-19 pneumonia
- Developed hypoxemic acute respiratory failure (hARF) requiring access to ICU
- Treated by respiratory physiotherapists during the hospitalization period
Exclusion Criteria:
- Previously documented neurological or neuromuscular diseases
- Passed over 1 month in bed before COVID-19 diagnosis
- Documented cognitive impairment (mini mental state examination <24)
Department of Pathophysiology and Transplantation, University of Milan Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Milan, Italy
Emilia Privitera, MSC, Principal Investigator
Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico