Early pulmonary rehabilitation for SARS-CoV-2 pneumonia: Experience from an intensive care unit outside of the Hubei province in China

Abstract

Dear Editor, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection mostly presents with mild respiratory symptoms, although more severely affected patients may die of refractory acute respiratory distress syndrome (ARDS). 1 The pulmonary function of surviving patients may decrease significantly in the early stages post-weaning due to the massive alveolar damage. Therefore, early pulmonary rehabilitation is important in these patients. We would like to share our experience of early pulmonary rehabilitation program in severe SARS-CoV-2 pneumonia.We received and successfully treated a 41-year-old man with severe SARS-CoV-2 pneumonia in the Intensive care unit (ICU) of the SARS-CoV-2 treatment center in Shenyang, China. This patient was supported with 11 days of mechanical ventilation and 9 days of extracorporeal membrane oxygenation as well as conventional supportive care. After weaning, a meticulous and individualized ICU rehabilitation program(see Fig. 1

Application and effectiveness of respiratory physiotherapy in the prevention and treatment of patients with Covid-19

“…Years before the appearance of COVID-19, it has been proven that regular physical activity increases the functional reserves of organs and maintains their physiological functionality, which in the case of respiratory diseases can have a diametrical impact in the fight against disease symptoms [28,29]. Considering the fact that the largest losses seen in complications after SARS are borne by the lungs and respiratory muscles, their activation should be started as soon as possible to maintain or improve their efficiency [30,31]. Besides, prolonged stay in isolation increases the risk of a decrease in immunity, by reducing the efficiency of the body due to lack of physical activity, which increases the risk of cardiovascular disease and lung disease [32].…”

“…The case analysis of a 41-year-old patient was documented based on physiotherapy performed in COVID-19 in the intensive care unit of the SARS-CoV-2 treatment center in Shenyang, China. Clinicians undertook to carry out an individualized process of patient rehabilitation based on the experience of the SARS epidemic and recommend based on the facts of the past to conduct therapy to avoid such significant complications as shortness of breath or pulmonary fibrosis [31].…”

Effects of Early Physical and Pulmonary Rehabilitation for Severely and Critically ill COVID-19 Patients: A Retrospective, Cohort, and Multicenter Study

“…However, to our knowledge, a limited number of studies have reported the impacts of early physical and pulmonary rehabilitation on COVID-19 patients, especially for severe and critical cases. For example, one case report shared the early pulmonary rehabilitation experiences of a 41-year-old severe patient with SARS-CoV-2 pneumonia 20 . Another study found that a six-week respiratory rehabilitation program produced positive impacts on COVID-19 patients aged over 65 by improving respiratory functions, quality of life, and exercise endurance, as well as relieving anxiety 21 .…”

Not only pulmonary rehabilitation for critically ill patients with COVID-19

“…From the start of the COVID-19 outbreak, an increasing amount of scientific literature focused on epidemiology, pathophysiology and, especially, on treatment in the acute phase of patients with severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) infection [1]. Pulmonary rehabilitation is recommended to reduce symptoms of respiratory failure and distress and to restore pre-morbid functionality in the acute [2] and post-acute phase of COVID-19 [3]. Tailored respiratory rehabilitation in severe acute respiratory distress aims at mechanical ventilation weaning, and improving ventilation and oxygenation [4].…”