Safe Rehabilitation Practices For COVID-19 Patients on Mechanical Ventilators in the Intensive Care Units

Yıl 2020, Cilt: 4 Sayı: 3, 114 - 121, 31.12.2020

Dinçer Cüre

Öz

A new type of coronavirus called Severe Acute Respiratory Syndrome (SARS-Cov-2) emerged in the city of Wuhan of China in December 2019. Due to its highly infectious nature, the new coronavirus (COVID-19) has spread over to more than 200 countries in the world and continues to infect more and more people worldwide. According to the World Health Organization, 5% of COVID-19 patients require the use of mechanical ventilators. Due to the fragility of the COVID-19 patients, it is of utmost importance that safe exercises that are supported with evidence are applied to these patients. Whole-body vibration, cycle ergometer, and electrical muscle stimulation were all investigated in this review and evaluated in terms of their safety, feasibility, practicality, and the quality of evidence presented. According to the current evidence in the literature, they were all deemed safe and feasible alternatives to active exercises that could put the patients’ health in jeopardy. Physiotherapists are recommended to work with the intensive care unit physicians regarding the implementation of these exercise programs and determine whether the patients with COVID-19 are suitable for the program. This review concluded that whole-body vibration, cycle ergometer, and electrical muscle stimulation modalities may serve as the safe rehabilitation practices for the physiotherapists worldwide to improve functional outcomes in patients with COVID-19, prevent muscle wasting, delirium, and decrease respiratory complications of COVID-19.

Anahtar Kelimeler

COVID-19, Whole body vibration, Cycle ergometer, Electrical muscle stimulation, early mobilization

Yoğun Bakım Ünitelerinde Mekanik Ventilatöre Bağlı Olan COVID-19 Hastaları İçin Güvenli Rehabilitasyon Uygulamaları

Öz

Aralık 2019'da Çin'in Wuhan şehrinde Şiddetli Akut Solunum Sendromu (SARS-Cov-2) adı verilen yeni bir koronavirüs türü ortaya çıktı. Oldukça bulaşıcı doğası nedeniyle, yeni koronavirüs (COVID-19) dünyada 200'den fazla ülkeye yayılmış ve dünya çapında giderek daha fazla insana bulaşmaya devam etmektedir. Dünya Sağlık Örgütüne göre, COVID-19 hastalarının %5'i mekanik ventilatör kullanımına ihtiyaç duymaktadır. COVID-19 hastalarının kırılganlığı nedeniyle, bu hastalara kanıtlarla desteklenen güvenli egzersizlerin uygulanması büyük önem taşımaktadır. Tüm vücut titreşimi, el-ayak ergometresi ve elektriksel kas stimülasyonu bu derlemede araştırılmış ve güvenlik, fizibilite, pratiklik ve ortaya konulan kanıt kalitesi açısından değerlendirilmiştir. Literatürdeki mevcut kanıtlara göre hepsi, hastaların sağlığını tehlikeye atabilecek aktif egzersizlerin yerine,hasta sağlığı açısından güvenli ve uygulanabilir alternatifler olarak uygun görüldü. Fizyoterapistlerin, bu egzersiz programlarının uygulanması konusunda yoğun bakım ünitesi doktorlarıyla çalışması ve COVID-19 hastalarının, program için uygun olup olmadığını belirlemeleri önerilir. Bu derleme, tüm vücut titreşimi, el-ayak ergometresi ve elektriksel kas stimülasyonu yöntemlerinin, COVID-19'lu hastalarda fonksiyonel sonuçları geliştirmek, kas erimesini, deliryumu ve COVID-19'un solunumsal komplikasyonlarını azaltmak amacıyla, tüm dünyadaki fizyoterapistler için güvenli rehabilitasyon uygulamaları olabileceği sonucuna varmıştır.

Anahtar Kelimeler

COVID-19, tüm vücut titretişimi, el-ayak ergometresi, elektriksel kas stimülasyonu, erken mobilizasyon

Kaynakça

• 1. Del Rio, C. and P.N. Malani, 2019 novel coronavirus—important information for clinicians. Jama, 2020. 323(11): p. 1039-1040.
• 2. Li, Q., X. Guan, P. Wu, X. Wang, L. Zhou, Y. Tong, et al., Early transmission dynamics in wuhan, china, of novel coronavirus–infected pneumonia. N Engl J Med, 2020. 382(13): p. 1199-1207.
• 3. Who. Who coronavirus disease (covid-19) dashboard. 2020 08.07.2020 Available from: https://covid19.who.int/?gclid=Cj0KCQjw3ZX4BRDmARIsAFYh7ZIcTYjwrn9qGqGyJIuVp6T6bQMHyh4Yj6yV4JO42ApKUdQVb4VxuogaAmVXEALw_wcB. [Accessed: 2020 08.07]
• 4. Guan, W.-J., Z.-Y. Ni, Y. Hu, W.-H. Liang, C.-Q. Ou, J.-X. He, et al., Clinical characteristics of coronavirus disease 2019 in china. N Engl J Med, 2020. 382(18): p. 1708-1720.
• 5. Who. Coronavirus disease 2019 (covid-19) situation report – 46. 2020 Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_4. [Accessed: 08.07.2020]
• 6. Sañudo, B., A. Seixas, R. Gloeckl, J. Rittweger, R. Rawer, R. Taiar, et al., Potential application of whole body vibration exercise for improving the clinical conditions of covid-19 infected individuals: A narrative review from the world association of vibration exercise experts (wavex) panel. International Journal of Environmental Research Public Health, 2020. 17(10): p. 3650-3673.
• 7. Kotfis, K., S. Williams Roberson, J.E. Wilson, W. Dabrowski, B.T. Pun, and E.W. Ely, Covid-19: Icu delirium management during sars-cov-2 pandemic. J Critical care, 2020. 24: p. 1-9.
• 8. Titsworth, W.L., J. Hester, T. Correia, R. Reed, P. Guin, L. Archibald, et al., The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg, 2012. 116(6): p. 1379-1388.
• 9. Team-Study-Investigators, Early mobilization and recovery in mechanically ventilated patients in the icu: A bi-national, multi-centre, prospective cohort study. J Critical Care, 2015. 19(1): p. 81-91.
• 10. Pun, B.T., M.C. Balas, M.A. Barnes-Daly, J.L. Thompson, J.M. Aldrich, J. Barr, et al., Caring for critically ill patients with the abcdef bundle: Results of the icu liberation collaborative in over 15,000 adults. Crit Care Med, 2019. 47(1): p. 3-14.
• 11. Ely, E.W., The abcdef bundle: Science and philosophy of how icu liberation serves patients and families. Crit Care Med, 2017. 45(2): p. 321-330.
• 12. Eymir, M., M. Erduran, and B. Ünver, Active heel-slide exercise therapy facilitates the functional and proprioceptive enhancement following total knee arthroplasty compared to continuous passive motion. Knee Surg Sports Traumatol Arthrosc, 2020. 28(8): p. 1-9.
• 13. Thomas, P., C. Baldwin, B. Bissett, I. Boden, R. Gosselink, C.L. Granger, et al., Physiotherapy management for covid-19 in the acute hospital setting: Clinical practice recommendations. Journal of Physiotherapy, 2020. 66(2): p. 73-82.
• 14. Deniz, İ., N.V. Yağli, M. Sağlam, and E.Ç. Kütükcü, Yeni tip koronavirüs (sars-cov-2) kaynakli covid-19 enfeksiyonunda akut dönem ve postakut dönemde fizyoterapi ve rehabilitasyon. Türk Fizyoterapi ve Rehabilitasyon Dergisi. 31(1): p. 81-93.
• 15. Felten-Barentsz, K.M., R. Van Oorsouw, E. Klooster, N. Koenders, F. Driehuis, E.H. Hulzebos, et al., Recommendations for hospital-based physical therapists managing patients with covid-19. Phys Ther, 2020. 100(9): p. 1444-1457.
• 16. Lazzeri, M., A. Lanza, R. Bellini, A. Bellofiore, S. Cecchetto, A. Colombo, 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(1): p. 163-168.
• 17. Dubb, R., P. Nydahl, C. Hermes, N. Schwabbauer, A. Toonstra, A.M. Parker, et al., Barriers and strategies for early mobilization of patients in intensive care units. Annals of the American Thoracic Society, 2016. 13(5): p. 724-730.
• 18. Olkowski, B.F. and S.O. Shah, Early mobilization in the neuro-icu: How far can we go? Neurocrit Care, 2017. 27(1): p. 141-150.
• 19. King, J. and J. Crowe, Mobilization practices in canadian critical care units. Journal of Physiotherapy Canada, 1998. 50(3): p. 206-211.
• 20. Morris, P.E., Moving our critically ill patients: Mobility barriers and benefits. Crit Care Clin, 2007. 23(1): p. 1-20.
• 21. Fan, E., F. Cheek, L. Chlan, R. Gosselink, N. Hart, M.S. Herridge, et al., An official american thoracic society clinical practice guideline: The diagnosis of intensive care unit–acquired weakness in adults. Am J Respir Crit Care Med, 2014. 190(12): p. 1437-1446.
• 22. Bailey, P., G.E. Thomsen, V.J. Spuhler, R. Blair, J. Jewkes, L. Bezdjian, et al., Early activity is feasible and safe in respiratory failure patients. Crit Care Med, 2007. 35(1): p. 139-145.
• 23. Thomsen, G.E., G.L. Snow, L. Rodriguez, and R.O. Hopkins, Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med, 2008. 36(4): p. 1119-1124.
• 24. Doiron, K.A., T.C. Hoffmann, and E.M. Beller, Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev, 2018. 3(3): p. 1-52.
• 25. Kayambu, G., R. Boots, and J. Paratz, Early physical rehabilitation in intensive care patients with sepsis syndromes: A pilot randomised controlled trial. Intensive Care Med, 2015. 41(5): p. 865-874.
• 26. Morris, P.E., M.J. Berry, D.C. Files, J.C. Thompson, J. Hauser, L. Flores, et al., Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure: A randomized clinical trial. Jama, 2016. 315(24): p. 2694-2702.
• 27. Schweickert, W.D., M.C. Pohlman, A.S. Pohlman, C. Nigos, A.J. Pawlik, C.L. Esbrook, et al., Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. Lancet, 2009. 373(9678): p. 1874-1882.
• 28. Patman, S., D. Sanderson, and M. Blackmore, Physiotherapy following cardiac surgery: Is it necessary during the intubation period? Australian Journal of Physiotherapy, 2001. 47(1): p. 7-16.
• 29. Monteleone, G., A. De Lorenzo, M. Sgroi, S. De Angelis, and L. Di Renzo, Contraindications for whole body vibration training. J Sports Med Phys Fitness, 2007. 47(4): p. 443-445.
• 30. Preiser, J., C. De Prato, A. Harvengt, L. Peters, M. Bastin, and V. Fraipont, Passive cycling limits myofibrillar protein catabolism in unconscious patients: A pilot study. J Nov Physiother, 2014. 4(4): p. 1-6.
• 31. Poitras, S. and L. Brosseau, Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy. The Spine Journal, 2008. 8(1): p. 226-233.
• 32. Rittweger, J., Vibration as an exercise modality: How it may work, and what its potential might be. Eur J Appl Physiol, 2010. 108(5): p. 877-904.
• 33. Wang, H.-H., W.-H. Chen, C. Liu, W.-W. Yang, M.-Y. Huang, and T.-Y. Shiang, Whole-body vibration combined with extra-load training for enhancing the strength and speed of track and field athletes. The Journal of Strength Conditioning Research, 2014. 28(9): p. 2470-2477.
• 34. Cochrane, D. and S. Stannard, Acute whole body vibration training increases vertical jump and flexibility performance in elite female field hockey players. Br J Sports Med, 2005. 39(11): p. 860-865.
• 35. Wollersheim, T., K. Haas, S. Wolf, K. Mai, C. Spies, E. Steinhagen-Thiessen, et al., Whole-body vibration to prevent intensive care unit-acquired weakness: Safety, feasibility, and metabolic response. J of Critical Care, 2017. 21(1): p. 1-10.
• 36. Bosveld, R. and E. Field-Fote, Single-dose effects of whole body vibration on quadriceps strength in individuals with motor-incomplete spinal cord injury. J Spinal Cord Med, 2015. 38(6): p. 784-791.
• 37. Jackson, K.J., H.L. Merriman, P.M. Vanderburgh, and C.J. Brahler, Acute effects of whole-body vibration on lower extremity muscle performance in persons with multiple sclerosis. Journal of Neurologic Physical Therapy, 2008. 32(4): p. 171-176.
• 38. Burtin, C., B. Clerckx, C. Robbeets, P. Ferdinande, D. Langer, T. Troosters, et al., Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med, 2009. 37(9): p. 2499-2505.
• 39. Kho, M.E., R.A. Martin, A.L. Toonstra, J.M. Zanni, E.C. Mantheiy, A. Nelliot, et al., Feasibility and safety of in-bed cycling for physical rehabilitation in the intensive care unit. J Crit Care, 2015. 30(6): p. 1419-1425.
• 40. Pires-Neto, R.C., Y.M.F. Kawaguchi, A.S. Hirota, C. Fu, C. Tanaka, P. Caruso, et al., Very early passive cycling exercise in mechanically ventilated critically ill patients: Physiological and safety aspects-a case series. J PLoS One, 2013. 8(9): p. 1-7.
• 41. Rodriguez, P.O., M. Setten, L.P. Maskin, I. Bonelli, S.R. Vidomlansky, S. Attie, et al., Muscle weakness in septic patients requiring mechanical ventilation: Protective effect of transcutaneous neuromuscular electrical stimulation. J Crit Care, 2012. 27(3): p. 319-326.
• 42. Routsi, C., V. Gerovasili, I. Vasileiadis, E. Karatzanos, T. Pitsolis, E. Tripodaki, et al., Electrical muscle stimulation prevents critical illness polyneuromyopathy: A randomized parallel intervention trial. J Crit Care, 2010. 14(2): p. 1-11.
• 43. Poulsen, J.B., K. Møller, C.V. Jensen, S. Weisdorf, H. Kehlet, and A. Perner, Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock. Crit Care Med, 2011. 39(3): p. 456-461.
• 44. Wang, H.-H., W.-H. Chen, C. Liu, W.-W. Yang, M.-Y. Huang, T.-Y.J.T.J.O.S. Shiang, et al., Whole-body vibration combined with extra-load training for enhancing the strength and speed of track and field athletes. 2014. 28(9): p. 2470-2477.
• 45. Burtin, C., B. Clerckx, C. Robbeets, P. Ferdinande, D. Langer, T. Troosters, et al., Early exercise in critically ill patients enhances short-term functional recovery. 2009. 37(9): p. 2499-2505.
• 46. Batt, J., C.C.D. Santos, J.I. Cameron, and M.S. Herridge, Intensive care unit–acquired weakness. Am J Respir Crit Care Med, 2013. 187(3): p. 238-246. 47. Herridge, M.S., Legacy of intensive care unit-acquired weakness. Crit Care Med, 2009. 37(10): p. 457-461.
• 48. Santos, C.D., S.N.A. Hussain, S. Mathur, M. Picard, M. Herridge, J. Correa, et al., Mechanisms of chronic muscle wasting and dysfunction after an intensive care unit stay. A pilot study. Am J Respir Crit Care Med, 2016. 194(7): p. 821-830.
• 49. Bagnato, S., C. Boccagni, G. Marino, C. Prestandrea, T. D’agostino, and F. Rubino, Critical illness myopathy after covid-19. International Journal of Infectious Diseases, 2020. 99: p. 276-278.
• 50. Pinzon, R.T., V.O. Wijaya, R.B. Buana, A. Al Jody, and P.N. Nunsio, Neurologic characteristics in coronavirus disease 2019 (covid-19): A systematic review and meta-analysis. Frontiers in Neurology, 2020. 11(1): p. 565-575.