Hospital Physical Therapy Management in Pediatric Patients With Covid-19: Case Reports

Abstract

Objective: To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil. Cases description: Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status. Comments: The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.

Chest Physiotherapy Interventions for Children During SARS-COV-2 Pandemic

“…Manual techniques, aiming at maintaining pulmonary expandability and promoting bronchial hygiene including compression/decompression, prolonged slow expiration (PSE), manual hyperinflation (MH) with self-inflating bag and bag squeezing enhanced recovery time post-COVID-19. 21 …”

“…Techniques involving airway clearance, pulmonary expansion, and activities to enhance mobilization (sessions involved passive to resistive exercises during hospitalization) have known to decrease dependency on ventilator and assist patients to walk unsupported at discharge, thereby augmenting recovery and enhancing their functional status. 24 , 25 …”

Efeito de modalidades fisioterapêuticas sobre os sinais vitais de crianças traqueostomizadas

“…Com relação a sua utilização em pediatria, descrita em algumas pesquisas como BS, a técnica tem sido relatada como parte da estratégia de tratamento fisioterapêutico em prematuros com síndrome do desconforto respiratório 17 , nos recém-nascidos e nos lactentes no pós-operatório de cirurgia cardíaca congênita 18 e no manejo de pacientes pediátricos com COVID-19 19 .…”

Casassola GM, Schmidt CJ, Affeldt G, Morais DS, Alvarenga LKB, Miller C, Ziegler B Functional status of hospitalized pediatric patients with COVID-19 in southern Brazil: a prospective cohort study

“…(3,4,7,8) Foi demonstrado que a COVID-19 causa várias sequelas, incluindo comprometimento das funções respiratórias e musculares, redução da funcionalidade e dificuldade em realizar tarefas diárias. (9,10) Tais alterações podem se manifestar em crianças como perda de marcos motores e atrasos no desenvolvimento motor. (10)(11)(12) Dentre os diversos profissionais que atuam no tratamento da COVID-19, os fisioterapeutas estão envolvidos no tratamento, prevenção e reabilitação das alterações funcionais causadas pela doença.…”

“…(9,10) Tais alterações podem se manifestar em crianças como perda de marcos motores e atrasos no desenvolvimento motor. (10)(11)(12) Dentre os diversos profissionais que atuam no tratamento da COVID-19, os fisioterapeutas estão envolvidos no tratamento, prevenção e reabilitação das alterações funcionais causadas pela doença. Portanto, a avaliação do estado funcional de pacientes com COVID-19 no momento da admissão hospitalar poderia contribuir para a triagem de pacientes mais graves e auxiliar na fisioterapia durante a internação.…”