فهرست مطالب alireza khafaee pour khamseh

 Challenges concerning patient management exist worldwide, particularly in the critical care. In this review, we have summarized some studies regarding respiratory physiotherapy and exercise in COVID-19 patients.   

 For searching related articles, PubMed, Google Scholar, Embase, and the Web of Science databases were used. Keywords such as "respiratory physiotherapy" and "COVID-19," "exercise," "effect of exercise in COVID-19," and "respiratory physiotherapy for COVID-19 in ICU" were used to identify related papers until December 2021. The abstracts and entire texts were evaluated by 3 separate reviewers.  

 During the symptomatic phase, individuals may benefit from brief durations of bed rest. Exercise appears to provide both emotional and physical benefits for individuals in the early stages of infection. As a result, it may lower viral load, minimize cytokine storm, shorten the acute phase, and expedite recovery. Mild exercise may also increase the autophagy pathway, which improves the immune system function in response to COVID-19 infection. Keeping this in mind, intense activity, especially without the guidance of an expert physical therapist, is not advantageous during the inflammatory period and may even be regarded a second hit phenomenon. Mild exercises during bed rest (e.g., acute phase) may reduce the risk of pulmonary capillary coagulation and deep vein thrombosis.  

 Although respiratory physiotherapy and prone positioning in hospitalized patients, particularly in critical care, can be challenging for medical staff, they are cost-effective and noninvasive approaches for COVID-19 patients. Early physiotherapy and muscle training exercise for patients in the intensive care unit (ICU) seems to be beneficial for patients and may reduce bed rest-induced weakness, improve oxygenation, and reduce length of stay. Finally, breathing exercises can improve some symptoms of COVID-19, like dyspnea and weakness.

Context:

 Severe coronavirus disease 2019 (COVID-19) can induce acute respiratory distress, which is characterized by tachypnea, hypoxia, and dyspnea. Intubation and mechanical ventilation are strategic treatments for COVID-19 distress or hypoxia.

 We searched PubMed, Embase, and Scopus databases to identify relevant randomized control trials, observational studies, and case series published from April 1, 2021.

 24 studies were included in this review. Studies had been conducted in the USA, China, Spain, South Korea, Italy, Iran, and Brazil. Most patients had been intubated in the intensive care unit. Rapid sequence induction had been mostly used for intubation. ROX index can be utilized as the predictor of the necessity of intubation in COVID-19 patients. According to the studies, the rate of intubation was 5 to 88%. It was revealed that 1.4 - 44.5% of patients might be extubated. Yet obesity and age (elderly) are the only risk factors of delayed or difficult extubation.

 Acute respiratory distress in COVID-19 patients could require endotracheal intubation and mechanical ventilation. Severe respiratory distress, loss of consciousness, and hypoxia had been the most important reasons for intubation. Also, increased levels of C-reactive protein (CRP), ferritin, d-dimer, and lipase in combination with hypoxia are correlated with intubation. Old age, diabetes mellitus, respiratory rate, increased level of CRP, bicarbonate level, and oxygen saturation are the most valuable predictors of the need for mechanical ventilation. ICU admission mortality following intubation was found to be 15 to 36%. Awake-prone positioning in comparison with high-flow nasal oxygen therapy did not reduce the risk of intubation and mechanical ventilation. There was no association between intubation timing and mortality of the infected patients. Noninvasive ventilation may have survival benefits.