Conceptual bases, elements of methodology and narrative aspects resulted from direct clinical experience – afferent to pulmonary rehabilitation in post COVID-19 patients

Abstract

Introduction. Coronavirus disease 2019 (COVID-19) has been declared as a new illness in December 2019 in Hubei Province, China and considered a pandemic by the WHO Director General`s opening remarks at the related media briefing in March 2020. This illness is caused by a virus called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). COVID-19 involves multiple organ impairments and lung injury is one of the most common lesions of this disease. Although it has been studied for nine months, our understanding of this disease is still incomplete, including in terms of sequelae and long-term outcomes. A large number of patients are affected by the COVID-19 pandemic but only in some patients the disease has progressed rapidly to respiratory failure requiring hospitalization or treatment in intensive care units. The most common complications noticed in severe cases is acute respiratory distress syndrome with a consecutive respiratory failure. Materials and method. The detailed evaluation of the patient, the methodological and fundamental elements of the pulmonary rehabilitation adapted to the patient are interventions which have an extremely important role and application in COVID-19 treatment, in mitigating dyspnoea symptoms, anxiety relief, reducing other possible complications, minimizing disability, maintaining functionality, all in order to increase the patient quality of life. As for October 2020 and still ongoing, a number of approximately fifty patients from both the Intensive Care Unit and clinical wards of “Prof. Dr. Matei Bals” National Institute of Infectious Disease have been evaluated by the physician and underwent a physical therapy program, assisted by the physiotherapist. Results. Lung rehabilitation should be considered when possible and safe during treatment of patients with COVID-19 and may include rehabilitative nursing, specific respiratory kinesiotherapy and for increasing general effort capacity and mobility (see further for methodological details). From the physician’s point of view, it is extremely important to carefully conduct the anamnestic process and evaluation, to adjust the program to each individual, to monitor oxygen saturation, blood pressure levels, pulse and temperature throughout the exercises. Every increment or decrement of these parameters, onset of cough or fatigability, must end the rehabilitation process. Conclusions. Like for all the chronic pulmonary patients in the cases where COVID-19 resulted in respiratory sequels, specific and connected general physical and kinesiological rehabilitative interventions are necessary and useful. The methodology must be thoroughly case by case elaborated and applied considering also the epidemiologic related concerns.