https://doi.org/10.4081/monaldi.2022.2087
Safety and feasibility of physiotherapy in ICU-admitted severe COVID-19 patients: an observational study
Submitted: September 14, 2021
Accepted: January 14, 2022
Published: January 27, 2022
Accepted: January 14, 2022
Abstract Views: 3477
PDF: 1938
Supplementary: 242
Supplementary: 242
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Early physiotherapy could play an important role in the management of severe COVID-19 subjects with consequences of prolonged ICU stay, although its effectiveness is still unclear. Aim of this study is to describe physiotherapy performed in severe COVID-19 patients and to evaluate its safety and feasibility. Consecutive adults with confirmed SARS-CoV-2 infection, admitted to the ICU, needing invasive mechanical ventilation for >24 hours and receiving early physiotherapy, have been enrolled. Adverse events occurred during physiotherapy sessions and timing and type of physiotherapy delivered were analysed, to identify the interventions most frequently performed and to determine the time taken to first mobilize, stand and walk. Functional and clinical assessment of patients was also performed at hospital discharge. Eighty-four severe COVID-19 subjects were enrolled. Few minor adverse events were recorded. Active mobilization was promoted over passive mobilization and independence in daily life activities was supported. Time interval from patients’ intubation to the first physiotherapy treatment was 13 days and to walking was 27 days. Forty-eight (57.1%) subjects returned at home, whereas 29 (34.5%) were discharged to in-patient rehabilitation. Patients with tracheostomy experienced a delay in time from ICU admission until sit out of bed and ambulation, if compared with subjects without tracheostomy, although no differences were found in 6MWT and 1m-STST performances. This study reporting early physiotherapy during pandemic suggests that this intervention is feasible and safe for severe COVID-19 subjects, as well as healthcare workers, although delayed compared to other critically ill patients.
Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: Early experience and forecast during an emergency response. JAMA 2020;323:1545–46.
DOI: https://doi.org/10.1001/jama.2020.4031
World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 2020. Available from: https://apps.who.int/iris/handle/10665/331446
DOI: https://doi.org/10.15557/PiMR.2020.0003
Wiersinga WJ, Rhodes A, Cheng AC, et al. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus Disease 2019 (COVID-19): A review. JAMA 2020;324:782-93.
DOI: https://doi.org/10.1001/jama.2020.12839
Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in critically ill patients in the Seattle region - case series. N Engl J Med 2020;382:2012-22.
DOI: https://doi.org/10.1056/NEJMoa2004500
Grasselli G, Greco M, Zanella A, et al. COVID-19 Lombardy ICU network. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med 2020;180:1345-55.
DOI: https://doi.org/10.1001/jamainternmed.2020.3539
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-81.
DOI: https://doi.org/10.1016/S2213-2600(20)30079-5
CDC COVID-19 Response Team. Severe outcomes among patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep 2020;69:343-46.
DOI: https://doi.org/10.15585/mmwr.mm6912e2
Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009;373:1874-82.
DOI: https://doi.org/10.1016/S0140-6736(09)60658-9
Kim RY, Murphy TE, Doyle M, et al. Factors associated with discharge home among medical ICU patients in an early mobilization program. Crit Care Explor 2019;1:e0060.
DOI: https://doi.org/10.1097/CCE.0000000000000060
Righetti RF, Onoue MA, Politi FVA, et al. Physiotherapy care of patients with Coronavirus Disease 2019 (COVID-19) - a Brazilian experience. Clinics (Sao Paulo) 2020;75:e2017.
DOI: https://doi.org/10.6061/clinics/2020/e2017
Lazzeri M, Lanza A, Bellini R, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis 2020;90:1285.
DOI: https://doi.org/10.4081/monaldi.2020.1285
Vitacca M, Carone M, Clini EM, et al. Joint Statement on the role of respiratory rehabilitation in the COVID-19 crisis: The Italian Position Paper. Respiration 2020;99:493-99.
DOI: https://doi.org/10.1159/000508399
Thomas P, Baldwin C, Bissett B, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother 2020; 66:73-82.
DOI: https://doi.org/10.1016/j.jphys.2020.03.011
Zhao HM, Xie YX, Wang C; Recommendations for respiratory rehabilitation in adults with coronavirus disease 2019. Chin Med J 2020;133:1595-602.
DOI: https://doi.org/10.1097/CM9.0000000000000848
McWilliams D, Weblin J, Hodson J, et al. Rehabilitation levels in patients with COVID-19 admitted to intensive care requiring invasive ventilation. An observational study. Ann Am Thorac Soc 2021;18:122-9.
DOI: https://doi.org/10.1513/AnnalsATS.202005-560OC
Armocida B, Formenti B, Ussai S, et al. The Italian health system and the COVID-19 challenge. Lancet Public Health 2020;5:e253.
DOI: https://doi.org/10.1016/S2468-2667(20)30074-8
Gambazza S. Respiratory physiotherapy education in Italy: per aspera ad astra. Breathe 2018;14:250-2.
DOI: https://doi.org/10.1183/20734735.021918
Aliberti S, Amati F, Pappalettera M, et al. COVID-19 multidisciplinary high dependency unit: the Milan model. Respir Res 2020;21:260.
DOI: https://doi.org/10.1186/s12931-020-01516-8
Bohannon RW, Crouch R. 1-Minute Sit-to-Stand Test: systematic review of procedures, performance, and clinimetric properties. J Cardiopulm Rehabil Prev 2019;39:2-8.
DOI: https://doi.org/10.1097/HCR.0000000000000336
Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014;44:1428-46.
DOI: https://doi.org/10.1183/09031936.00150314
Stevens RD, Marshall SA, Cornblath DR, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med 2009;37:S299-308.
DOI: https://doi.org/10.1097/CCM.0b013e3181b6ef67
Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J 1965;14:61-5.
DOI: https://doi.org/10.1037/t02366-000
McWilliams D, Atkins G, Hodson J, et al. Feasibility and reliability of the Manchester Mobility Score as a measure of physical function within the Intensive Care Unit. ACPRC J 2015;48:26–33.
DOI: https://doi.org/10.1186/2197-425X-3-S1-A553
Retucci M, Aliberti S, Ceruti C, et al. Prone and lateral positioning in spontaneously breathing patients with COVID-19 pneumonia undergoing noninvasive helmet CPAP treatment. Chest 2020;158: 2431-35.
DOI: https://doi.org/10.1016/j.chest.2020.07.006
Nydahl P, Ruhl AP, Bartoszek G, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med 2014;42:1178-86.
DOI: https://doi.org/10.1097/CCM.0000000000000149
Koo KK, Choong K, Cook DJ, et al. Early mobilization of critically ill adults: a survey of knowledge, perceptions and practices of Canadian physicians and physiotherapists. CMAJ Open 2016;4:E448-54.
DOI: https://doi.org/10.9778/cmajo.20160021
Harrold ME, Salisbury LG, Webb SA, Allison GT. Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers. Crit Care 2015;19:336.
DOI: https://doi.org/10.1186/s13054-015-1033-3
Privitera E, D'Abrosca F, Gaudiello G, et al. Physiotherapist involvement in the pandemic era: a Lombardy region survey. Monaldi Arch Chest Dis 2021;91:1762.
DOI: https://doi.org/10.4081/monaldi.2021.1762
Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397:220-32.
DOI: https://doi.org/10.1016/S0140-6736(20)32656-8
Parry SM, Nalamalapu SR, Nunna K, et al. Six-minute walk distance after critical illness: A systematic review and meta-analysis. J Intensive Care Med 2021;36:343-51.
DOI: https://doi.org/10.1177/0885066619885838
Skinner EH, Haines KJ, Berney S, et al. Usual care physiotherapy during acute hospitalization in subjects admitted to the ICU: An observational cohort study. Respir Care 2015;60:1476-85.
DOI: https://doi.org/10.4187/respcare.04064
Belli S, Balbi B, Prince I, et al. Low physical functioning and impaired performance of activities of daily life in COVID-19 patients who survived the hospitalisation. Eur Respir J 2020;56:2002096.
DOI: https://doi.org/10.1183/13993003.02096-2020
Shimogai T, Izawa KP, Kawada M, Kuriyama A. Factors affecting discharge to home of medical patients treated in an intensive care unit. Int J Environ Res Public Health 2019;16:4324.
DOI: https://doi.org/10.3390/ijerph16224324
How to Cite
Rossi, Veronica, Martina Santambrogio, Cesare Del Monaco, Mariangela Retucci, Serena Tammaro, Clara Ceruti, Laura Saderi, et al. 2022. “Safety and Feasibility of Physiotherapy in ICU-Admitted Severe COVID-19 Patients: An Observational Study”. Monaldi Archives for Chest Disease 92 (4). https://doi.org/10.4081/monaldi.2022.2087.
Copyright (c) 2022 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Gianfranco Beghi, Antonio De Tanti, Paolo Serafini, Chiara Bertolino, Antonietta Celentano, Graziella Taormina, Monitoring of hospital acquired pneumonia in patients with severe brain injury on first access to intensive neurological rehabilitation: First year of observation , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Muhammad Ijaz, Muhammad Jaffar Khan, Jawad Khan, . Usama, Association of clinical characteristics of patients presenting with influenza like illness or severe acute respiratory illness with development of acute respiratory distress syndrome , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- Carlos A. Jiménez-Ruiz, Marcos Garcia Rueda, Manuel A. Martinez Muñiz, Jacobo Sellarés, Maria A. Jiménez-Fuentes, Lourdes Lázaro Asegurado, Esther RodrÃguez Gonzalez, Concepción Rodriguez Garcia, Oriol Armengol, Emilia Abad, Teresa Peña, Adolfo Domenech del Rio, Juan A. Riesco Miranda, Varenicline in smokers with severe or very severe COPD after 24 weeks of treatment. A descriptive analysis: VALUE study , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Massimiliano Polastri, Lara Pisani, Andrea Dell'Amore, Stefano Nava, Revolving door respiratory patients: A rehabilitative perspective , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Marinella Sommaruga, Elisabetta Angelino, Paola Della Porta, Mara Abatello, Giacomo Baiardo, Gianluigi Balestroni, Ornella Bettinardi, Edward Callus, Chiara Ciracì, Ombretta Omodeo, Claudia Rizza, Paolo Michielin, Marco Ambrosetti, Raffaele Griffo, Roberto F.E. Pedretti, Antonia Pierobon, Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper , Monaldi Archives for Chest Disease: Vol. 88 No. 2 (2018)
- Roberto F.E. Pedretti, Francesco Fattirolli, Raffaele Griffo, Marco Ambrosetti, Elisabetta Angelino, Silvia Brazzo, Ugo Corrà , Nicolò Dasseni, Pompilio Faggiano, Giuseppe Favretto, Oreste Febo, Marina Ferrari, Francesco Giallauria, Cesare Greco, Manuela Iannucci, Maria Teresa La Rovere, Mario Mallardo, Antonio Mazza, Massimo Piepoli, Carmine Riccio, Simonetta Scalvini, Luigi Tavazzi, Pier Luigi Temporelli, Gian Francesco Mureddu, Cardiac Prevention and Rehabilitation “3.0â€: From acute to chronic phase. Position Paper of the ltalian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Francesco Giallauria, Lucrezia Piccioli, Giuseppe Vitale, Filippo M. Sarullo, Exercise training in patients with chronic heart failure: A new challenge for Cardiac Rehabilitation Community , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- C. Incorvaia, C. Pravettoni, M. Mauro, M.-R. Yacoub, F. Tarantini, G.G. Riario-Sforza, Effectiveness of omalizumab in a patient with severe asthma and atopic dermatitis , Monaldi Archives for Chest Disease: Vol. 69 No. 2 (2008): Pulmonary series
- Susanna Ricotti, Valentina Martinelli, Patrick Caspani, Serena Monteleone, Lucia Petrucci, Elena Dalla Toffola, Catherine Klersy, Changes in quality of life and functional capacity after lung transplantation: A single-center experience , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Joo Ock Na, Dong Soon Kim, Seong Ho Yoon, Yang Jin Jegal, Woo Sung Kim, Eung Suk Kim, Myung Wha Kim, A simple and easy home-based pulmonary rehabilitation programme for patients with Chronic Lung Diseases , Monaldi Archives for Chest Disease: Vol. 63 No. 1 (2005): Pulmonary series
You may also start an advanced similarity search for this article.
