COVID-19 ENFEKSİYONUNDA AKUT VE POST-AKUT FİZYOTERAPİ VE REHABİLİTASYON

Year 2020, , 81 - 93, 13.04.2020

Deniz İnal İnce Naciye Vardar Yağlı Melda Sağlam Ebru Çalık Kütükcü

https://doi.org/10.21653/tjpr.718877

Cited By: 14

Abstract

COVID-19 enfeksiyonu Aralık 2019’da Çin’in Wuhan kentinde ortaya çıkmış ve kısa sürede başta
Avrupa olmak üzere tüm Dünya’da etkili olmuştur. Hastaların yaklaşık % 80'inde, pnömoni içermeyen
hafif ile orta derecede hastalık gelişmektedir. Viral pnömoni vakalarının % 14’ünde, şiddetli hastalık
ortaya çıkmaktadır. Bazı hastaların respiratuar durumu giderek kötüleşmeye devam etmekte ve
genellikle üçüncü haftaya kadar uzayan mekanik ventilasyon desteği gerektiren akut solunum
sıkıntısı sendromu (ARDS) geliştirmektedir. COVID-19 enfeksiyonu akut döneminde solunum işi
ve distresini artıran uygulamaların (havayolu temizleme tekniklerinin solunum egzersizlerinin,
egzersiz eğitiminin ve solunum kas eğitimi) kullanılması önerilmemektedir. Bu hastalarda önerilen
yaklaşımlar pozisyonlama ve sedasyon ve klinik durumun el verdiği oranda uygulanabilen pasif veya
aktif mobilizasyondur. Akut dönemde bu uygulamalar sırasında kesin/olası COVID-19 enfeksiyonu
olan hastalar ile temas durumunda, öncelikle T.C. Sağlık Bakanlığı standart temas ve damlacık
enfeksiyonuna yönelik koruma önlemlerine uyulması ve kişisel koruyucu ekipman (KKE) kullanılması
gerekmektedir. Akut dönem sonrasında (post-akut) güncel sınırlı bilgiler ışığında, COVID-19
enfeksiyonunun, uzamış mekanik ventilasyonun ve yoğun bakımda uzun süreli kalışın yaratacağı
olası respiratuar, fonksiyonel ve emosyonel kayıplarla başa çıkmada fizyoterapi ve rehabilitasyon
yararlı olabilir. COVID-19 enfeksiyonunun respiratuar, kardiyovasküler, nörolojik ve musküler etkileri
ve komorbid durumlar göz önünde bulundurularak, düşük şiddette aktivite ve egzersizin bireysel
temelde uygulanması önerilebilir. COVID-19 enfeksiyonu Dünya’da 100. Gün ve Türkiye’de ise 30.
gününü henüz tamamlamıştır. Günden güne literatür bilgilerinde ve yapılan önerilerde belirgin
değişiklikler yapılması gerekebilmektedir. Bu derleme, eldeki güncel bilgiler ışığında, COVID-19
enfeksiyonunda akut ve post-akut dönemde fizyoterapi ve rehabilitasyon uygulamalarına yön
gösterici olmak amacı ile hazırlanmıştır.

Keywords

Solunum Sıkıntısı Sendromu, COVID-2019, Fizyoterapi, Pnömoniler

References

• 1. COVID-19 (SARS-CoV2) Enfeksiyonu Rehberi (Bilim Kurulu Çalışması). T.C. Sağlık Bakanlığı. Halk Sağlığı Genel Müdürlüğü. T.C. Sağlık Bakanlığı. (https://www.sanko.edu.tr/ wp-content/uploads/2020/03/Saglik-Bakanligi-COVID-19- rehberi-23032020.pdf.pdf). Erişim Tarihi: 30 Mart 2020. 2. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim Guidance, 2020. Erişim Tarihi: 5 Nisan 2020. WHO Reference number WHO/2019-nCoV/clinical/2020.4 3. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al., for the Zhongnan Hospital of Wuhan University Novel Coronavirus Management and Research Team, Evidence-Based Medicine Chapter of China International Exchange and Promotive Association for Medical and Health Care (CPAM). A rapid advice guideline for the diagnosis and treatment of 2019 Novel Coronavirus (2019-nCoV) infected pneumonia (Standard Version). Mil Med Res. 2020;7(1):4. 4. Spruit MA, Holland AE, Singh SJ, Troosters T. Report of an AdHoc International Task Force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in COVID-19 survivors. https://ers.app. box.com/s/npzkvigtl4w3pb0vbsth4y0fxe7ae9z9. E r i ş i m Tarihi: 1 Nisan 2020. 5. General Office of National Health Committee. Office of State Administration of Traditional Chinese Medicine. Notice on the issuance of a programme for the diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (Trial Version 4). 2020.http://bgs.satcm.gov.cn/ zhengcewenjian/2020-01-28/12576.html. Erişim tarihi: 29 Ocak 2020. 6. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. 7. Gattinoni L, Coppola S, Cressoni M, Busana M, Chiumello D. COVID-19 does not lead to a “typical” acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020. doi:10.1164/ rccm.202003-0817LE. 8. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System A Review. JAMA Cardiol. 2020 doi:10.1001/jamacardio.2020.1286 9. Wenzhong L, Hualan L. COVID-19: atacks the beta-1 chain of hempglobin captures the porphyrin to inhibit human heme metobolism. ChemRxiv. 2020. https://chemrxiv.org/articles/ COVID19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_ Heme_Metabolism_by_Binding_to_Porphyrin/11938173. Erişim Tarihi: 10 Nisan 2020. 10. Bornstein SR, Dalan R, Hopkins D, Mingrone G, Boehm BO. Endocrine and metabolic link to coronavirus infection Nat Rev Endocrinol. 2020; doi: 10.1038/s41574-020-0353-9. 11. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al., for the China Medical Treatment Expert Group for Covid-19* clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020. doi: 10.1056/NEJMoa2002032. 12. Mao L, Wang M, Chen S, He Q, Chang J, Hong C, et al. Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: a retrospective case series study BMJ Yale 2020; doi: https://doi.org/10.1101/2020.02.22.20026500. 13. Weiss SR, Leibowitz JL. Coronavirus pathogenesis. Adv Virus Res. 2011;81:85-164. doi: 10.1016/B978-0-12-385885-6.00009-2. 14. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924. 15. Chung M, BernheimA, MeiX, ZhangN, HuangM, ZengX, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology. 2020. doi:10.1148/radiol.2020200230. 16. Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging coronavirus 2019-nCoV pneumonia. Radiology. 2020. doi:10.1148/radiol.2020200274. 17. Lazzaeri M, Lanza A, Bellini R, Bellofiore A, Cecchetto S, Colombo A, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a position paper of Italian Association of Respiratory Physiotherapists. Monaldi Arch Chest Dis. 2020;90:1285. doi: 10.4081/monaldi.2020.1285. 18. Ferioli M, Cisternino C, Leo V, Pisani L, Palange P, Nava S. Protecting healthcare workers from SARS-CoV-2 infection: practical indications. Eur Respir Rev. 2020;29:200068. 19. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL. Physiotherapy management for COVID-19 in the acute hospital setting: recommendations to guide clinical practice. J Physiotherapy 2020. Doi: https://doi.org/10.1016/j. jphys.2020.03.011. 20. Wilson KC, Chotirmall SH, Bai C, Rello J, on behalf of the International Task Force on COVID-19. COVID-19: Interim guidance on management pending empirical evidence. From an American Thoracic Society led International Task Force. Available at www.thoracic.org/professionals/clinicalresources/ diseaserelatedresources/covid19 guidance.pdf. Erişim Tarihi: 6 Nisan 2020. 21. Vitacca M, Carone M, Clini E, Paneroni M, Lazzeri M, Lanza A, et al. Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: the Italian position paper. www.aiponet.it, 2020. Erişim Tarihi: 30 Mart 2020. 22. Türkiye Fizyoterapistler Derneği. COVID-19 enfeksiyonunda fizyoterapi ve rehabilitasyon. https://drive.google.com/file/d/1 iwzxxxVVCMUI27Ug74Wl1bRPb09EkYni/view. Erişim Tarihi: 9 Nisan 2020. 23. Koh GC, Hoeing H. How should the rehabilitation community prepare for 2019-nCoV? Arch Phys Med Rehabil. 2020. doi: 10.1016/j.apmr.2020.03.003. 24. Thomas PJ, Paratz JD, Stanton WR, Deans R, Lipman J. Positioning practices for ventilated intensive care patients: current practice, indications and contraindications. Aust Crit Care. 2006;19(4):122-6, 128, 130-2. 25. Comellini V, Artigas A, Nava S. Respiratory physiotherapy in critically ill patients. ICU Management Practice. 2019;19:100-8. 26. Ambrosino N, Makhabah DN. Comprehensive physiotherapy management in ARDS. Minerva Anestesiol. 2013;79(5):554-63. 27. Brochard L, Slutsky A, Pesenti A.. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med. 2017;195(4):438-42. 28. Jang MH, Shin MJ, Shin YB. Pulmonary and physical rehabilitation in critically ill patients. Acute Crit Care. 2019; 34(1):1-13. 29. Park WB, Poon LLM, Choi SJ, Choe PG, Song KH, Bang JH et al. Replicative virus shedding in the respiratory tract of patients with Middle East respiratory syndrome coronavirus infection. Int J Infect Dis. 2018;72:8-10. doi: 10.1016/j.ijid.2018.05.003. 30. Hashem MD, Nelliot A, Needham DM. Early mobilization and rehabilitation in the ICU: moving back to the future. Respir Care. 2016;61(7):971-9. 31. McNeary L, Maltser S, Verduzco-Gutierrez M. Navigating Coronavirus Disease 2019 (Covid-19) in physiatry: a CAN report for inpatient rehabilitation facilities. PM R. 2020 Mar 20. doi: 10.1002/pmrj.12369. 32. Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Med. 2020;46(4):637-53. 33. Gandotra S, Lovato J, Case D, Bakhru RN, Gibbs K, Berry M, et al. Physical function trajectories in survivors of acute respiratory failure. Ann Am Thorac Soc. 2019;16(4):471-7. 34. Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, et al; Canadian Critical Care Trials Group. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293-304. 35. Bansal M. Cardiovascular disease and COVID-19. Diabetes Metab Syndr. 2020; 14(3):247-50. 36. Zhou L, Zhang M, Wang J, Gao J. SARS-Cov-2: underestimated damage to nervous system. Travel Med Infect Dis. 2020:101642. doi: 10.1016/j.tmaid.2020.101642. 37. Hsieh MJ, Lee WC, Cho HY, Wu MF, Hu HC, Kao KC, et al. Recovery of pulmonary functions, exercise capacity, and quality of life after pulmonary rehabilitation in survivors of ARDS due to severe influenza A (H1N1) pneumonitis. Influenza Other Respir Viruses. 2018;12(5):643-8. 38. Mikkelsen ME, Shull WH, Biester RC, Taichman DB, Lynch S, Demissie E, et al. Cognitive, mood and quality of life impairments in a select population of ARDS survivors. Respirology. 2009;14(1):76-82. 39. Marra A, Pandharipande PP, Girard TD, Patel MB, Hughes CG, Jackson JC, et al. Co-occurrence of post-intensive care syndrome problems among 406 survivors of critical illness. Crit Care Med. 2018;46(9):1393-1401. 40. Luyt CE, Combes A, Becquemin MH, Beigelman-Aubry C, Hatem S, Brun AL, et al. REVA Study Group. Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe ARDS. Chest. 2012;142(3):583-92. 41. Chinese Association of Rehabilitation Medicine; Respiratory rehabilitation Committee of Chinese Association of Rehabilitation Medicine; Cardiopulmonary rehabilitation Group of Chinesen Society of Physical Medicine and Rehabilitation. Recommendations for respiratory rehabilitation of COVID-19 in adult. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(0):E029. doi: 10.3760/cma.j.cn112147-20200228-00206.