Mini Review
Corona virus (CoV) was first discovered in 1960 among adults
and children suffering from respiratory infection. It is termed
severe acute respiratory distress syndrome (SARS) as it affects
upper and lower respiratory tract [1]. The first case of corona was
reported in Wuhan city of China at the start of December 2019 [2].
It was initially presented as pneumonia in several person without
any known cause, however some report showed that people
suffering from this disease had a contact history in local Chinese
seafood market [3]. CDC identified the novel corona virus by taking
swab sample from throat of affected patient, which was named
as Covid-19 by WHO [4]. The patients affected with corona virus
present with a variety of symptoms from no or mild symptoms to
severe breathing difficulty or even in worse conditions leading to
organ damage including renal and cardiac failure. Pyrexia, malaise,
productive cough, difficulty breathing, muscle weakness, and
headache are some of the common symptoms. Other less common
symptoms included runny nose, diarrhea, and blood during cough,
chest pain, and nausea [5]. The virus spreads when a healthy
individual inhales infected particles released through respiratory
secretions of an affected person, which travels within a range of 2m
from infected person. SARS-CoV stays active on hard surfaces for
twenty four hours while on soft surfaces it remains for eight hours.
The infected particles released through cough and sneeze remain
active for less than three hours in air [6].
During Covid-19 pandemic it is a difficult task to manage huge
number of infected patients while simultaneously dealing with
noninfectious patients suffering from other medical problem [7].
A major concern during pandemic is increased patient load on
emergency departments. In an emerging collaborative model of
care, physical therapists assists emergency department physicians
in diagnosis and treatment of neuromusculoskeletal and ambulatory
disorders e.g., occurrence of fall in elderly persons, vertigo, low
back pain etc. [8] Physical therapists working in emergency
departments reduces inpatient admissions for musculoskeletal
injuries and also decrease overcrowding of persons during
pandemic reducing burden in emergency departments [8]. Globally,
Physiotherapy is a well-known profession and physiotherapists
play a key role in wellbeing of patients admitted in hospital with
confirmed or suspected cases of Covid-19 [9]. Physiotherapists
performs rehabilitation and respiratory management of Corona
affected patients. Productive cough is an uncommon symptom
reported in Covid-19 patients [10] however, patients who has other
diseases like cystic fibrosis, neurological diseases have in-effective
cough and face difficulty in clearing copious respiratory secretion
[11]. Covid-19 patients associated with respiratory failure
have insufficient airway clearance. Physiotherapist may help in
positioning of ventilated patients for air clearance and optimization
of oxygen supply by adopting prone position for patients [12]. The
risk for ICU acquired muscular weakness is greater in Covid-19
patients who are admitted in ICU for prolong intensive treatment at
hospital, which limit their mobility and increase risk for mortality
among Covid-19 patients [13,14]. Physiotherapy rehabilitation
is necessary to start promptly in Covid-19 patients to decrease
risks for ICU acquired weakness and to add functional return to home in surviving patients of Covid-19 [9]. Post-intensive
care syndrome (PIC) is likely to occur in Covid-19 patients after
critical illness resulting in physical impairments, decrease lung
functions, cognitive impairments, depression decreased muscle
strength affecting ability to perform ADLS and IADLS [15]. After
early examination and screening done by physiotherapist, these
impairments can be managed properly [16].
It is advantageous to provide conventional oxygen therapy
via facemask in respiratory distress patients (target SpO2 > 94
%). It also suggested to use face mask to avoid dispersal of virus
contaminants [17]. The risk of contamination and transmission
of viral droplets are greater in nasal cannula that is why not
recommended in Covid-19 patients [18]. High flow nasal oxygen
are preferable with a 60% of flow rate. Surgical mask should be
properly place on patient mouth and nose as used in conventional
oxygen therapy and should be changed after six or eight hours of use
[19]. If one hour of non-invasive ventilation /continuous positive
airway pressure shows no improvement, then medical team should
be informed and treatment should be shifted to invasive ventilator
technique. It is necessary to perform all procedures with prevention
and control measures taken properly [20]. Regular change in
position is recommended in mechanical ventilated Covid-19
patients to improve ventilation and for prevention of bed sores.
Semi-prone and prone positions are recognized for better gaseous
exchange and improving lung functions in Covid-19 patients. To
minimize muscle work while maintaining stable position, use of
pillow or cushion is recommended [21]. Nebulizers and humidifiers
are not recommended in Covid-19 patients due to increased risk for
disease transmission. However, if it is required can be used with
proper precautions to prevent aerial dispersion of viral droplets
by use of antiviral filters in nebulizers [22]. A decrease in lung
compliance is observed in acute Covid-19 and respiratory failure
patients with an increased work of breathing [23]. Therefore
certain physical therapy interventions should not be practiced in
acute Covid-19 patients as these may increase load on respiratory
muscle and increase work of breathing i.e., pursed lip breathing,
cleaning of nasal pathways, exercise training, spirometer, manual
mobilizations, mobility during acute instability [18] Physiotherapist
play a vital role in rehabilitation of Covid-19 patients. The duration
in hospital stay can be minimized and return to functional activities
can be achieved by early mobilizing the patient (Passive and active
ROM, bed mobility, sitting balance, sit to stand transitions, standing,
tilt table) [24].
References
- Malik YS, Sircar S, Bhat S, Sharun K, Dhama K, et al. (2020) Emerging novel coronavirus (2019-nCoV)-current scenario, evolutionary perspective based on genome analysis and recent developments. Veterinary quarterly 40(1): 68-76.
- (2020) Organization WH. Novel coronavirus (2019-nCoV). Situation report p. 28.
- Chen N, Zhou M, Dong X, Qu J, Gong F, et al. (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet 395(10223): 507-513.
- Huang C, Wang Y, Li X, Ren L, Zhao J, et al. (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet 395(10223): 497-506.
- Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, et al. (2020) Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. bmj pp. 368.
- Van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, et al. (2020) Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. New England Journal of Medicine 382(16): 1564-1567.
- Ranney ML, Griffeth V, Jha AK (2020) Critical supply shortages-the need for ventilators and personal protective equipment during the Covid-19 pandemic. New England Journal of Medicine 382(18): e41.
- Kim HS, Strickland KJ, Mullen KA, Lebec MT (2018) Physical therapy in the emergency department: A new opportunity for collaborative care. The American journal of emergency medicine 36(8): 1492-1496.
- Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, et al. (2020) Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. Journal of Physiotherapy 66(2): 73-82.
- Guan WJ, Ni ZY, Hu Y, Liang W, Ou CQ, et al. (2020) Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine 382(18): 1708-1720.
- Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, et al. (2020) Physiotherapy management for COVID-19 in the acute hospital setting: Recommendations to guide clinical practice. Pneumon 33(1).
- (2020) ANZICS COVID-19 Guidelines.
- Kress JP, Hall JB (2014) ICU-acquired weakness and recovery from critical illness. New England Journal of Medicine 370(17): 1626-1635.
- Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, et al. (2011) Functional disability 5 years after acute respiratory distress syndrome. New England Journal of Medicine 364(14): 1293-1304.
- Ohtake PJ, Lee AC, Scott JC, Hinman RS, Ali NA, et al. (2018) Physical Impairments Associated With Post–Intensive Care Syndrome: Systematic Review Based on the World Health Organization's International Classification of Functioning, Disability and Health Framework. Physical therapy 98(8): 631-645.
- Fan E, Dowdy DW, Colantuoni E, Mendez-Tellez PA, Sevransky JE, et al. (2014) Physical complications in acute lung injury survivors: a 2-year longitudinal prospective study. Critical care medicine 42(4): 849-859.
- (2020) Organization WH. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 13 March 2020. World Health Organization.
- Lazzeri M, Lanza A, Bellini R, Bellofiore A, Cecchetto S, et al. (2020) Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Archives for Chest Disease 90(1).
- Hui DS, Chow BK, Lo T, Tsang OT, Ko FW, et al. (2019) Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks. European Respiratory Journal 53(4): 1802339.
- (2020) Delle Infezioni IC. Indicazioni Per La Fisioterapia Respiratoria In Pazienti Con Infezione Da COVID-191.
- Ding L, Wang L, Ma W, He H (2020) Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study. Critical care 24(1): 28.
- Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, et al. (2020) Physiotherapy management for COVID-19 in the acute. JAMA 323(11): 1039-1040.
- Wujtewicz M, Dylczyk Sommer A, Aszkiełowicz A, Zdanowski S, Piwowarczyk S, et al. (2020) COVID-19–what should anaethesiologists and intensivists know about it? Anaesthesiology intensive therapy 52(1): 34-41.
- Respiratory Management of COVID 19 2020.