Chest Physiotherapy for COVID-19 Cases
Introduction
Coronavirus Disease-2019 (COVID-19) as we all know is extremely communicable. WHO has announced a fresh name for the COVID-19 outbreak as Coronavirus-2 (SARS-CoV-2) severe acute respiratory syndrome.
Latest, findings show that patients aged 60 years are at greater risk than children who could even be less likely to become compromised or may have milder or perhaps asymptomatic symptoms. In the intensive care units approximately 5 percent admission rates and approximately 42 percent of admitted patients might need oxygen.
This varies from other respiratory viruses which are transmitted between 2 to 10 days before symptoms occur. This virus is transmitted by droplet from sneezing and coughing within 2m of the infected person from person to person via respiratory secretions. This virus remains live for a minimum of 24 hours on the hard surfaces and approximately 8 hours on the soft surfaces.
The virus may additionally be transmitted by hand contact from person to person if it’s touched on contaminated surface then touched by the nose, mouth and eyes. This can be often often possible that closed environments make a secondary impact COVID-19 dissemination and promotion of super spreading events. Virus stays 3 hours viable within the air.
The range of illness varies from mild which is commonest to severe illness which needs treatment monitoring and mechanical ventilator. Individuals infected with COVID-19 produce symptoms like fever, sneezing, raw throat, cough, fatigue, sputum & shortness of breath. The extent varies from asymptomatic infection or mild URTI with respiratory failure and death may occur to pneumonia.
Present reports are estimated to be asymptomatic in 80 percent of cases, severe in 15 percent of cases requiring oxygen, and significant in 5 percent requiring ventilator and life support. within the pneumonia is that the foremost typical serious appearance of infection within which about 81% patients were laid low with mild infection and about 43% of patients had only fever and about 13% patients no symptoms throughout the illness.
Mostly the affected population is that the elderly and folk having severe co-morbidities like diabetes, cardiac diseases, cancer or on chemotherapy drugs, chronic nephrosis on dialysis, post transplant and patients having lung disease are mostly affected. Children’s were rarely affected and if they get infected usually have a light-weight disease.
It also finally ends up in various complications i.e Severe pneumonia, Acute respiratory distress syndrome, Sepsis, Septic shock, Multiple organ failure, Acute kidney injury, Cardiac injury. Chest x-ray indicating pneumonia, but initial results indicate that chest x-rays in COVID19 could have diagnostic limitations clinicians do must be mindful that lung CT scanning findings show significant mottling and ground glass opacity. Lung ultrasound is additionally a diagnostic tool which might be used on the bedside, displaying effects of multi-lobar B lines distribution and diffuse lung consolidation.
Physiotherapy for Covid Patients
Physiotherapy is an well-known profession everywhere the planet, which they work mostly in hospital wards and ICUs to treat acute likewise as chronic cases. specifically, acts on patients with acute and chronic respiratory problems by cardio respiratory PT.
There are attempts to boost physical and mental disability in patients. Physiotherapy may additionally be important to patients with COVID19 within the respiratory care and physical treatment. For this case, sputum secretion could also be a smaller amount normal (34 percent), physiotherapy should only be performed if patients have excessive airway secretions that can’t be independently clear.
High-risk patients can even get pleasure from prior co-morbid conditions with elevated rates of secretion within adequate cough (for example patients of hereditary condition, neuromuscular disease and respiratory disorder).
Physiotherapists employed in ICU provide patients with intubation with airway clearance techniques and folk showing signs of inadequate airway clearance can even be useful in patients with serious respiratory failure with COVID19 (prone to maximizing oxygenation position). future ventilation, continuous sedation and use of neuromuscular blocking agents may intensify their morbidity and mortality by those admitted to ICU with high risk of developing ICU acquired weakness. Therefore, initiating early physiotherapy care after the acute respiratory distress stage is incredibly important so on stop the impairment acquired by the ICU and to market functional recovery.
Physiotherapy’s job is to produce therapies, organize patients and rehabilitate those critically ill related to COVID19 to form patients functionally independent.
Indications for physiotherapy treatment
Patients with dry and non-productive cough with lower involvement within the tract are typically not reported to possess pneumonitis during this case. during this case physiotherapy is usually recommended to patients who experience exudative aggregation, secretion and difficulty in removing the secretions also ICU patients developed weakness.
Treatment is additionally indicated in Patients with pneumonia or lower tract infection with elevated oxygen requirements, fever, breathing difficulties; regular, efficient coughing and ultrasound changes within the throat, CT or lung.
Goals of physiotherapy management
To retaining bronchial hygiene and airway clearing, to scale back phases of shortness of breath, to cut back the prospect of a mechanical ventilator, to remain up active range of motion in ventilated patients, to cut back infection spread, to want care of mobility of the chest wall, to cut back reliance on a mechanical ventilator, to revive muscular and pulmonary functions.
Physiotherapy Management
Chest Physiotherapy
Techniques for clearing airways include positioning, active breathing cycle, manual and/or ventilator hyperinflation, percussion, vibrations, positive expiratory pressure therapy (PEP) and also the insufflation-exsufflation mechanical.
Non-invasive ventilation and inspiratory positive pressure breathing
Inspiratory positive pressure breathing is used by physiotherapists (e.g. rib fractures). Airway clearance strategies may include non-invasive ventilation in Respiratory malfunction control, or during exercise.
Techniques for supporting the clearance of secretions
Techniques for promoting the clearance of secretions include helped or induced cough manoeuvres and suction by airway.
Other Therapy
Physiotherapists advise exercises, and help mobilize patients. Physiotherapists also play a giant role in treating tracheostomy patients.
Tracheostomy management
Closed in line suction is used to chop back the assembly of aerosols. Inspiratory muscle training shouldn’t lean until the chance of transmission is lower.
Guidelines for patients with COVID-19 taking respiratory treatment
Patients should cover their mouth once they’re coughing through their elbows or sleeves or in an tissue and also the tissue should be disposed of and hygienized by hand. If necessary physiotherapists should be quite 2 m far from the patient. there isn’t any evidence to support incentive spirometry in COVID19 patients. If possible avoid the employment of non-invasive ventilation, mechanical insufflation / exsufflation, inspiratory positive pressure breathing devices or if they’re indicated and alternative options are ineffective, then confirm that machines with viral filters are going to be decontaminated after use over machine ends and patient ends and machines. Disposable circuits should be used for these devices. Physiotherapist should wear full airborne PPE if physiotherapy is required to push a sputum examination. When a sample has been collected a biohazard label should be labelled. A staffer wearing PPE will put it double bagged and within the isolation room. Specimen should be presented by the one who understands the laboratory by hand character of specimen. Saline nebulisation mustn’t be used.
Mobilization
Physiotherapists are likely to be in direct contact with the patient when delivering care like mobilization and activities that really need support which they will use a high filtration mask, i.e. P2 / N95, when providing care. Sometimes mobilization and exercise might also produce cough in patients, ensuring that patients wear a mask while mobilizing patients outside the isolation room. Patients should be treated with physiotherapy only those with severe functional disabilities (ICU acquired disability, frailty, various comorbidities) and a stronger aged category. we should encourage early mobilization to attenuate further complications. Patients will get out of bed ready and elicit basic exercises and ADL’s. The equipment required for the treatment should be negotiated with the local authorities Service personnel monitoring and prevention of infections before use. Use resistant elastic bands instead of distributing hand weights so it are often used alone. Larger equipment like walking aids, chairs, cycle ergometer, and tilt tables must be decontaminated with ease.
Conclusions
The importance of physiotherapy within the treatment of covid19 patients in ICU with appropriate guidelines is discussed during this study. The special environment for Physiotherapists is ICU and also they’re integral component of multi disciplinary group. In COVID 19 ICU cases, the employment of chest physiotherapy methods helps control symptoms faster along with treatment and contributes to reduced risk of developing hospital infection. the foremost widely used methods in hospital environment & ICU treatment management by the physiotherapist are handiest strategies in bronchial hygiene during clinical practice. Effective upper and lower limb movement on a mechanical ventilator in patients during ICU can decrease the complication and help to preserve peripheral oxygen delivery along with inactive blood supply for better health. This blog also suggests that the involvement of the chest physiotherapist within the medical care unit leads to the patient’s early recovery and reduces the duration of be artificial ventilation and hospitalization.