Respiration
Interventional Pulmonology
Joint Statement on the Role of Respiratory Rehabilitation in the COVID-19 Crisis: The Italian Position PaperVitacca M.a · Carone M.b · Clini E.M.c · Paneroni M.a · Lazzeri M.d · Lanza A.e · Privitera E.f · Pasqua F.g · Gigliotti F.h · Castellana G.b · Banfi P.i · Guffanti E.j · Santus P.k · Ambrosino N.l · on behalf of the ITS - AIPO, the ARIR and the SIP/IRSaRespiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
bRespiratory Rehabilitation of the Institute of Bari, Istituti Clinici Scientifici Maugeri IRCCS, Bari, Italy cDepartment of Medical and Surgical Sciences SMECHIMAI, University of Modena and Reggio Emilia, Modena, Italy dDepartment of Cardiothoracic and Vascular Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy eSleep Medicine Center, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy fHealth Professions Department Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy gPulmonary Rehabilitation, Istituto Clinico Riabilitativo hPulmonary Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi Hospital, Florence, Italy iPulmonary Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi Hospital, Milan, Italy jRehabilitative Pneumology, Former INRCA IRCCS, Casatenovo, Lecco, Italy kDivision of Respiratory Diseases, Department of Biomedical and Clinical Sciences L. Sacco, Ospedale Universitario L. Sacco – ASST Fatebenefratelli Sacco, Università degli Studi di Milano, Milan, Italy lRespiratory Rehabilitation of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy |
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Article / Publication Details
Received: April 20, 2020
Accepted: May 02, 2020
Published online: May 19, 2020
Issue release date: July 2020
Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3
ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)
For additional information: https://www.karger.com/RES
Abstract
Due to the exponential growth of the number of subjects affected by coronavirus disease 2019 (COVID-19), the entire Italian health care system had to respond promptly and in a very short time with the need of semi-intensive and intensive care units. Moreover, trained dedicated COVID-19 teams consisting of physicians were coming from different specialties (intensivists or pneumologists and infectiologists), while respiratory therapists and nurses have been recruited to work on and on without rest. However, due to still limited and evolving knowledge of COVID-19, there are few recommendations concerning the need in respiratory rehabilitation and physiotherapy interventions. The presentation of this paper is the result of a consensus promoted by the Italian societies of respiratory health care professionals who contacted pulmonologists directly involved in the treatment and rehabilitation of COVID-19. The aim was to formulate the more proper and common suggestions to be applied in different hospital settings in offering rehabilitative programs and physiotherapy workforce planning for COVID-19 patients. Two main areas of intervention were identified: organization and treatment, which are described in this paper to face the emergency.
© 2020 S. Karger AG, Basel
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References
-
Worldometer. COVID-19 coronavirus pandemic [cited 2020 Mar 19]. Available from: https://www.worldometers.info/coronavirus/
-
World Health Organization. Global surveillance for human infection with coronavirus disease (COVID-2019) [cited 2020 Mar 19]. Available from: https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov)
-
Istituto Superiore di Sanità. Coronavirus – epidemiological data [cited 2020 Mar 19]. Available from: https://www.epicentro.iss.it/coronavirus
- Zhang Y, Xu J, Li H, Cao B. A novel coronavirus (COVID-19) outbreak: a call for action. Chest. 2020 Apr;157(4):e99–101. Epub.
- Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al.; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020 Feb;382(8):727–33.
- 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 Feb;395(10223):497–506.
-
Vitacca S, Nava S, Pintus A, Harari S. Facing the respiratory SARS-CoV-2 emergency in Italy: from ward to trenches. Eur Respir J. DOI: 10.1183/13993003.00632-2020. Forthcoming.
External Resources
- Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al.; ATS/ERS Task Force on Pulmonary Rehabilitation. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct;188(8):e13–64.
- Yang F, Liu N, Wu JY, Hu LL, Su GS, Zheng NS. [Pulmonary rehabilitation guidelines in the principle of 4S for patients infected with 2019 novel coronavirus (2019-nCoV)]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Feb;43(0):E004.
- Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020 Mar;66(2):S1836-9553(20)30028-X.
-
Spruit MA, Holland AE, Singh SJ. Troosters T. Report of an ad-hoc 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 (version April 3, 2020) [cited 2020 Apr 7]. Available from: www.ersnet.org
-
Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani – IRCCS. Protocollo di gestione clinica e raccolta dati dei casi confermati di malattia da infezione da coronavirus – 2019 (COVID-19) nel paziente adulto – 19 March 2020. A cura dell’INMI COVID-19 group, con la collaborazione della Rete Regionale di Malattie infettive, dei PS/DEA e delle Terapie Intensive [cited 2020 Mar 26]. Available from: https://www.inmi.it/seresmi
-
World Health Organization. Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19) [cited 2020 Mar 19]. Available from. https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf
-
Ministero della Salute. Circolare Ministero della Salute n. 5443 del 22 February 2020 [cited 2020 Mar 24]. Available from: http://www.prefettura.it/FILES/allegatinews/1181/Circolare_Ministero_della_Salute_n._5443_del_22_febbraio_2020.pdf
-
Chinese Association of Rehabilitation Medicine; Respiratory rehabilitation committee of Chinese Association of Rehabilitation Medicine; Cardiopulmonary rehabilitation group of Chinese Society of Physical Medicine and Rehabilitation. Recommendations for respiratory rehabilitation of COVID-19 in adults. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Apr;43(4):308–14. Chinese.
External Resources
- Ambrosino N, Clini EM. Response to pulmonary rehabilitation: toward personalised programmes? Eur Respir J. 2015 Dec;46(6):1538–40.
- Wouters EF, Wouters BB, Augustin IM, Houben-Wilke S, Vanfleteren LE, Franssen FM. Personalised pulmonary rehabilitation in COPD. Eur Respir Rev. 2018 Mar;27(147):170125.
-
The first affiliated Hospital, Zhejiang University School of Medicine. Compiled according to clinical experience: rehabilitation therapy for COVID-19 patients. In Zhejiang University, editors. Handbook of COVID-19, prevention and treatment 2020: p. 47–8 [cited 2020 Mar 27]. Available from: http://www.zju.edu.cn/english/2020/0323/c19573a1987520/page.htm
- Esquinas AM, Egbert Pravinkumar S, Scala R, Gay P, Soroksky A, Girault C, et al.; International NIV Network. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review. Eur Respir Rev. 2014 Dec;23(134):427–38.
-
Gosselink R, Clini E. Rehabilitation in intensive care. In: Clini E, Holland A, Pitta F, Troosters T, editors. Textbook of pulmonary rehabilitation. Cham: Springer Nature; 2018. p. 349–66.
External Resources
- van der Lee L, Hill AM, Patman S. Expert consensus for respiratory physiotherapy management of mechanically ventilated adults with community-acquired pneumonia: A Delphi study. J Eval Clin Pract. 2019 Apr;25(2):230–43.
- Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev. 2018 Mar;3:CD010754.
- Ambrosino N, Makhabah DN. Comprehensive physiotherapy management in ARDS. Minerva Anestesiol. 2013 May;79(5):554–63.
- Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May;373(9678):1874–82.
- Connolly B, O’Neill B, Salisbury L, Blackwood B; Enhanced Recovery After Critical Illness Programme Group. Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews. Thorax. 2016 Oct;71(10):881–90.
- Hanekom S, Gosselink R, Dean E, van Aswegen H, Roos R, Ambrosino N, et al. The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice. Clin Rehabil. 2011 Sep;25(9):771–87.
- Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014 Dec;29(6):1082–8.
- Guarracino F, Bertini P, Bortolotti U, Stefani M, Ambrosino N. Flexible bronchoscopy during mechanical ventilation in the prone position to treat acute lung injury. Rev Port Pneumol. 2013 Jan-Feb;19(1):42–4.
- Medrinal C, Combret Y, Prieur G, Robledo Quesada A, Bonnevie T, Gravier FE, et al. Comparison of exercise intensity during four early rehabilitation techniques in sedated and ventilated patients in ICU: a randomised cross-over trial. Crit Care. 2018 Apr;22(1):110.
- Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, et al.; Prone-Supine Study Group. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med. 2001 Aug;345(8):568–73.
- Karatzanos E, Gerovasili V, Zervakis D, Tripodaki ES, Apostolou K, Vasileiadis I, et al. Electrical muscle stimulation: an effective form of exercise and early mobilization to preserve muscle strength in critically ill patients. Crit Care Res Pract. 2012;2012:432752.
- Fossat G, Baudin F, Courtes L, Bobet S, Dupont A, Bretagnol A, et al. Effect of in-bed leg cycling and electrical stimulation of the quadriceps on global muscle strength in critically ill adults: a randomized clinical trial. JAMA. 2018 Jul;320(4):368–78.
- Fuke R, Hifumi T, Kondo Y, Hatakeyama J, Takei T, Yamakawa K, et al. Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: a systematic review and meta-analysis. BMJ Open. 2018 May;8(5):e019998.
- Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al; PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun;368(23):2159–68.
- Lazzeri 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 the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. 2020 Mar;90(1): https://doi.org/10.4081/monaldi.2020.1285.; Epub ahead of print.
- 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 Sep;12(5):643–8.
- Orme J Jr, Romney JS, Hopkins RO, Pope D, Chan KJ, Thomsen G, et al. Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2003 Mar;167(5):690–4.
- Hill AD, Fowler RA, Burns KE, Rose L, Pinto RL, Scales DC. Long-term outcomes and healthcare utilization after prolonged mechanical ventilation. Ann Am Thorac Soc. 2017 Mar;14(3):355–62.
- Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al; BRAIN-ICU Study Investigators. Long-term cognitive impairment after critical illness. N Engl J Med. 2013 Oct;369(14):1306–16.
- Girard TD, Alhazzani W, Kress JP, Ouellette DR, Schmidt GA, Truwit JD, et al.; ATS/CHEST Ad Hoc Committee on Liberation from Mechanical Ventilation in Adults. An official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: liberation from mechanical ventilation in critically ill adults. Rehabilitation protocols, ventilator liberation protocols, and cuff leak tests. Am J Respir Crit Care Med. 2017 Jan;195(1):120–33.
-
Vitacca M, Clini EM, Nava S, Ambrosino N. La riabilitazione ad alta complessità nel paziente con svezzamento prolungato: ruolo dello pneumologo. “Position paper” di un “experts’ panel.” Rassegna di Patologia dell’Apparato Respiratorio. 2013 Jul-Aug;28(4):179–87.
- Ambrosino N, Vitacca M. The patient needing prolonged mechanical ventilation: a narrative review. Multidiscip Respir Med. 2018 Feb;13(1):6.
- Ceriana P, Nava S, Vitacca M, Carlucci A, Paneroni M, Schreiber A, et al. Noninvasive ventilation during weaning from prolonged mechanical ventilation. Pulmonology. 2019 Nov - Dec;25(6):328–33.
- Winck JC, Gilet H, Kalin P, Murcia J, Plano F, Regnault A, et al. Validation of the Multi-INdependence Dimensions (MIND) questionnaire for prolonged mechanically ventilated subjects. BMC Pulm Med. 2019 Jun;19(1):109.
- Schreiber AF, Ceriana P, Ambrosino N, Malovini A, Nava S. Physiotherapy and weaning from prolonged mechanical ventilation. Respir Care. 2019 Jan;64(1):17–25.
- Ambrosino N, Venturelli E, Vagheggini G, Clini E. Rehabilitation, weaning and physical therapy strategies in chronic critically ill patients. Eur Respir J. 2012 Feb;39(2):487–92.
- Bissett BM, Leditschke IA, Neeman T, Boots R, Paratz J. Inspiratory muscle training to enhance recovery from mechanical ventilation: a randomised trial. Thorax. 2016 Sep;71(9):812–9.
- Vorona S, Sabatini U, Al-Maqbali S, Bertoni M, Dres M, Bissett B, et al. Inspiratory muscle rehabilitation in critically ill adults. A systematic review and meta-analysis. Ann Am Thorac Soc. 2018 Jun;15(6):735–44.
- Donner CF, Raskin J, ZuWallack R, Nici L, Ambrosino N, Balbi B, et al. Incorporating telemedicine into the integrated care of the COPD patient: a summary of an interdisciplinary workshop held in Stresa, Italy, 7-8 September 2017. Respir Med. 2018 Oct;143:91–102.
- Ambrosino N, Fracchia C. The role of tele-medicine in patients with respiratory diseases. Expert Rev Respir Med. 2017 Nov;11(11):893–900.
Article / Publication Details
Received: April 20, 2020
Accepted: May 02, 2020
Published online: May 19, 2020
Issue release date: July 2020
Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3
ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)
For additional information: https://www.karger.com/RES
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