Physiotherapy Care of Patients with Coronavirus Disease 2019 (COVID-19) - A Brazilian Experience

Abstract

Some patients with coronavirus disease (COVID-19) present with severe acute respiratory syndrome, which causes multiple organ dysfunction, besides dysfunction of the respiratory system, that requires invasive procedures. On the basis of the opinions of front-line experts and a review of the relevant literature on several topics, we proposed clinical practice recommendations on the following aspects for physiotherapists facing challenges in treating patients and containing virus spread: 1. personal protective equipment, 2. conventional chest physiotherapy, 3. exercise and early mobilization, 4. oxygen therapy, 5. nebulizer treatment, 6. non-invasive ventilation and high-flow nasal oxygen, 7. endotracheal intubation, 8. protective mechanical ventilation, 9. management of mechanical ventilation in severe and refractory cases of hypoxemia, 10. prone positioning, 11. cuff pressure, 12. tube and nasotracheal suction, 13. humidifier use for ventilated patients, 14. methods of weaning ventilated patients and extubation, and 15. equipment and hand hygiene. These recommendations can serve as clinical practice guidelines for physiotherapists. This article details the development of guidelines on these aspects for physiotherapy of patients with COVID-19.

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Figure 1. Proposal for oxygen therapy and early transfer to intensive care units for patients with respiratory distress and hypoxemia based on Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). SaO2: arterial oxygen saturation; ICU: intensive care unit; PPE: Personal protective equipment; NIV: non-invasive ventilation; HFNO: high-flow nasal oxygen.

Figure 2. Proposal for non-invasive ventilation and high-flow nasal oxygen for patients with COVID-19. NIV: non-invasive ventilation; EPAP: expiratory positive airway pressure; IPAP: inspiratory positive airway pressure; TV: tidal volume; FiO2: fraction of inspired oxygen; HFNO: high-flow nasal oxygen; SaO2: arterial oxygen saturation.

Figure 3. Bag-Valve-Mask device: (A) face mask, (B) heat moisture exchange filter, and (C) Bag-Valve-Mask.

Figure 4. Spontaneous breathing test device for tracheostomized patients: (A) heat moisture exchange filter (HMEF), (B) closed endotracheal suction (Trach-care), (C) site for connection of oxygen therapy in HMEF. (D) connection for the tracheostomy.