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

Yıl 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

Öz

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.

Anahtar Kelimeler

Solunum Sıkıntısı Sendromu, COVID-2019, Fizyoterapi, Pnömoniler

Kaynakça

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