Role of Rehabilitation Department for Adult Individuals With COVID-19: The Experience of the San Raffaele Hospital of Milan

Abstract

The rapid evolution of the health emergency linked to the spread of severe acute respiratory syndrome coronavirus 2 requires specifications for the rehabilitative management of patients with coronavirus disease 2019 . The symptomatic evolution of patients with COVID-19 is characterized by 2 phases: an acute phase in which respiratory symptoms prevail and a postacute phase in which patients can show symptoms related to prolonged immobilization, to previous and current respiratory dysfunctions, and to cognitive and emotional disorders. Thus, there is the need for specialized rehabilitative care for these patients. This communication reports the experience of the San Raffaele Hospital of Milan and recommends the setup of specialized clinical pathways for the rehabilitation of patients with COVID-19. In this hospital, between February 1 and March 2, 2020, about 50 patients were admitted every day with COVID-19 symptoms. In those days, about 400 acute care beds were created (intensive care/infectious diseases). In the following 30 days, from March 2 to mid-April, despite the presence of 60 daily arrivals to the emergency department, the organization of patient flow between different wards was modified, and several different units were created based on a more accurate integration of patients' needs. According to this new organization, patients were admitted first to acute care COVID-19 units and then to COVID-19 rehabilitation units, post-COVID-19 rehabilitation units, and/or quarantine/observation units. After hospital discharge, telemedicine was used to follow-up with patients at home. Such clinical pathways should each involve dedicated multidisciplinary teams composed of pulmonologists, physiatrists, neurologists, cardiologists, physiotherapists, neuropsychologists, occupational therapists, speech therapists, and nutritionists.

Covid-19 Cognitive Deficits After Respiratory Assistance in the Subacute Phase: A Covid-Rehabilitation Unit Experience

“…[1] In all these various clinical conditions, patients can present with cardiorespiratory, neurologic or systemic complications, leading to the need for functional rehabilitation for about 20% of hospitalized patients. [1][2][3][4] Nonetheless, in the first months, hospitals tended to discharge patients as soon as possible to face the increasing needs for hospital admissions. A communication from the San Raffaele Hospital of Milan reported that, in the exponential phase of the national pandemic, about 25% of patients needed specialized rehabilitation to address cardiorespiratory, motor and/or cognitive dysfunctions in the subacute phase.…”

Injury-prone: peripheral nerve injuries associated with prone positioning for COVID-19-related acute respiratory distress syndrome

“… 1 , 2 Many of the most severely affected survivors from COVID-19 are now being discharged to inpatient rehabilitation hospitals. 3 This provides an important opportunity to assess the long-term sequelae of prone positioning in this patient population. Here, we describe 11 patients who were diagnosed with acquired peripheral nerve injury in association with the use of prone positioning for COVID-19-related ARDS.…”

Insights into neurological dysfunction of critically ill COVID-19 patients

“…Respiratory, neurocognitive, and physical, rehabilitation must be considered as standard. Rehabilitation clinical pathways should include a dedicated multidisciplinary team made up of pulmonologists, neurologists, cardiologists, nutritionists, physiotherapists, and neuropsychologists [ 83 ].…”

“…A recent paper reported that up to 80% of patients discharged from the ICU and admitted to rehabilitation facilities present abnormal mini mental status examination (MMSE) or Montreal Cognitive Assessment (MoCA) [ 83 ]. This is significant, as these changes have a great impact on their daily lives.…”