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Review
. 2020 Nov:282:103529.
doi: 10.1016/j.resp.2020.103529. Epub 2020 Aug 17.

Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19

Denise Battaglini  1 , Chiara Robba  2 , Salvatore Caiffa  3 , Lorenzo Ball  4 , Iole Brunetti  2 , Maurizio Loconte  2 , Daniele Roberto Giacobbe  5 , Antonio Vena  5 , Nicolò Patroniti  4 , Matteo Bassetti  6 , Antoni Torres  7 , Patricia Rm Rocco  8 , Paolo Pelosi  4
Affiliations
Review

Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19

Denise Battaglini et al. Respir Physiol Neurobiol. 2020 Nov.

Abstract

In late 2019, an outbreak of a novel human coronavirus causing respiratory disease was identified in Wuhan, China. The virus spread rapidly worldwide, reaching pandemic status. Chest computed tomography scans of patients with coronavirus disease-2019 (COVID-19) have revealed different stages of respiratory involvement, with extremely variable lung presentations, which require individualized ventilatory strategies in those who become critically ill. Chest physiotherapy has proven to be effective for improving long-term respiratory physical function among ICU survivors. The ARIR recently reported the role of chest physiotherapy in the acute phase of COVID-19, pointing out limitation of some procedures due to the limited experience with this disease in the ICU setting. Evidence on the efficacy of chest physiotherapy in COVID-19 is still lacking. In this line, the current review discusses the important role of chest physiotherapy in critically ill mechanically ventilated patients with COVID-19, around the weaning process, and how it can be safely applied with careful organization, including the training of healthcare staff and the appropriate use of personal protective equipment to minimize the risk of viral exposure.

Keywords: COVID-19; Chest physiotherapy; Extubation; Mechanical ventilation; SARS-CoV-2.

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Conflict of interest statement

All authors declare they have no conflict of interests.

Figures

Fig. 1
Fig. 1
Genoa−COVID-19 algorithm for respiratory physiotherapy. Chest physiotherapy techniques commonly used in our COVID-19 unit during mechanical ventilation, before and after extubation. CIP, critical illness polyneuropathy; ZEEP, zero PEEP; PEEP, positive end-expiratory pressure; HEPA, exhalation/expiratory filter; EPAP, expiratory positive airway pressure; CPAP, continuous positive airway pressure; HFNO, high flow nasal oxygen; NIV, non-invasive ventilation.
Fig. 2
Fig. 2
Stepwise recruitment manoeuvres and lung ultrasound. Results of chest physiotherapy evaluated by lung ultrasound. The figure represents a stepwise recruitment manoeuvres (RM) at different positive end-expiratory pressure (PEEP) levels that allowed to recruit atelectatic areas of a COVID-19 patient.
Fig. 3
Fig. 3
Genoa−COVID-19 subglottic secretion drainage novel technique. Genoa−COVID-19 subglottic secretion drainage technique using a mixture of closed aspiration circuit and open aspiration circuit to minimize airborne dispersion.
Fig. 4
Fig. 4
Genoa−COVID-19 algorithm for extubation and weaning. Algorithm for weaning and extubation of COVID-19 patients routinely used in our intensive care unit. PS, pressure support; PEEP, positive end-expiratory pressure; FiO2, fraction of inspired oxygen; SpO2, peripheral saturation of oxygen; P/F, partial pressure of oxygen/FiO2 ratio; RR, respiratory rate; Vt, tidal volume; SBT, spontaneous breathing trial; PSV, pressure support ventilation; PaCO2, partial pressure of carbon dioxide; PBW, predicted body weight; NIV, non-invasive ventilation; CPAP, continuous positive airway pressure.
See this image and copyright information in PMC

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