Long-term complications of prone position ventilation with relevance for acute and postacute rehabilitation: a systematic review of the literature.

INTRODUCTION: Prone positioning ventilation (PPV) is an effective treatment for patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite the benefits of PPV, different kinds of short and long-term consequences have been noted. This review summarizes long-term complications of PPV that impact treatment strategies and outcomes in acute and postacute rehabilitation. EVIDENCE ACQUISITION: PubMed/Medline, Cochrane Library, Cochrane COVID-19 Study Register databases and the Google Scholar search engine were systematically searched for studies investigating long-term complications of PPV. The final search date for all sources/databases was January 31, 2022. For our methodological appraisal, we conducted a systematic review of articles without any restrictions on types of articles or publication dates. Only articles published in English and available as full texts were eligible for inclusion. After the screening process, data of interest were extracted from eligible sources: PPV sequelae and conclusions (i.e. possible effects on the course of rehabilitation and therapy strategies). EVIDENCE SYNTHESIS: A total of 59 studies are included in this review. Long-term consequences are mainly pressure ulcers and nerve lesions that exist after discharge from the Intensive Care Unit (ICU). Publications rarely recommend treatment strategies for long-term complications after PPV. Due to the quality of the included studies, no robust conclusions as to effective strategies can be drawn. CONCLUSIONS: Further high-quality research is required, considering the different long-term complications after PPV and their impact on rehabilitation in order to draw conclusions about viable physical therapies. Crucially, however, prone positioning (PP) sequelae pose new challenges to physicians and therapists in acute and postacute rehabilitation medicine as well as follow-up care.

[Acute rehabilitation after COVID-19 infection : A selected case series]. / Akutrehabilitation nach COVID­19­Infektion : Eine ausgewählte Fallserie.

BACKGROUND: While the first wave of the coronavirus disease 2019 (COVID-19) pandemic mainly affected the old, currently younger patients also become infected and hospitalized. After severe and critical COVID-19 infections and also after surviving acute phase symptoms, these patients often show symptoms (e.g. exertional dyspnea), organ damage (e.g. of the lungs, the cardiovascular system) as well as psychological impairments. OBJECTIVE: The severe courses after critical cases of COVID-19 represent challenges for rehabilitation and require more than ever rehabilitative treatment approaches even in acute hospitals. METHODS: This article presents a selected case series of patients with a typical constellation of pre-existing conditions due to immunosuppression plus critical course of COVID-19 and indications for acute rehabilitation. RESULTS: This case series depicts the long duration of hospitalization with high numbers of hours on ventilation in the intensive care unit. At the time of transfer to acute rehabilitation these patients are immobile and have severe limitations in all activities of daily life, so that an inpatient rehabilitation in an acute hospital is indicated and the usual means of continuation of rehabilitation were not feasible. The sequelae of lying prone and complications, such as exertional desaturation in the early stage of convalescence are detected in the acute phase of early rehabilitation. CONCLUSION: After severe COVID-19 infections new challenges for rehabilitation are to be expected, so that rehabilitative treatment approaches with an interdisciplinary early rehabilitation in an acute hospital are urgently needed. Finally, acute rehabilitation not only enables a seamless treatment chain for these patients but also the flow of patients from the intensive care unit to ensure the functioning of local infrastructures.

Folgeschäden durch Beatmung in Bauchlage bei COVID-19 und ihre Relevanz für die Frührehabilitation – eine retrospektive Kohortenstudie

Background Prone positioning is a therapy option for patients with Acute Respiratory Distress Syndrome. It has become more relevant and common during the COVID-19 pandemic. Among known side effects, pressure ulcers (PU) and peripheral nerve lesions (PNL) are the most relevant Methods In this retrospective cohort study we investigated the prevalence of PU and PNLin COVID-19 patients, who had been treated with prone positioning and had later been referred to an acute rehabilitation unit. Potential determinants for the occurrence of PU and PNL were identified. Potential effects of PU and PNL on the functional outcome of patients after acute rehabilitation were assessed. Results 52 patients were included in this study. 78.8% had typical ventral PU at the time of referral to the acute rehabilitation unit, 10% showed clinical features of PNL. Patients with PNL had diabetes as a preexisting condition more frequently than patients without. The occurrence of PU could not be correlated with any risk factor. On admission to acute rehabilitation patients with PNL were less mobile and less selfsufficent than patients without PNL, however on discharge there were no more differences in mobility and self-sufficency. Patients with PNL needed significantly more aids. PU are very common, mainly affecting the face and neck (56,1%). Conclusion This study shows that complications of BL are common on admission to acute rehabilitation. While mobility is lower on admission of patients with PNL, no such difference can be seen on discharge. Overall, patients with proning sequae don't seem to be impaired in their mobility and ADL performance beyond their time in acute rehabilitation.

Akutrehabilitation nach COVID‑19‑Infektion : Eine ausgewählte Fallserie Acute rehabilitation after COVID-19 infectionA selected case series

Hintergrund Waren in den ersten Wellen noch deutlich ältere Patienten von der COVID-19-Pandemie betroffen, so erkranken aktuell auch junge Patienten und werden hospitalisiert. Häufig zeigen diese Patienten nach schweren und kritischen Verläufen auch nach überstandener Akutphase Symptome (z. B. Belastungsdyspnoe), Organschädigungen (z. B. an Lunge, Herz-Kreislauf) sowie psychische Beeinträchtigungen. Fragestellung Die schweren Verläufe nach kritischer COVID-19-Erkrankung stellen die Rehabilitation vor neue Herausforderungen und fordern mehr denn je rehabilitative Behandlungsansätze bereits im Akutkrankenhaus. Methodik Es erfolgt die Darstellung einer ausgewählten Fallserie von Patienten mit einer typischen Konstellation mit Vorerkrankung durch Immunsuppression plus kritischem COVID-19-Verlauf sowie Indikation für eine Akutrehabilitation. Ergebnisse Diese Fallserie stellt die lange Liegedauer mit hoher Anzahl an Beatmungsstunden auf der Intensivstation dar. Bei Übernahme auf die Akutrehabilitation sind diese Patienten immobil sowie stark eingeschränkt in sämtlichen Alltagsaktivitäten, sodass eine stationäre Rehabilitation im Akutkrankenhaus indiziert ist und übliche fortführende Rehabilitationsangebote nicht infrage kommen können. Proningfolgen und Komplikationen wie beispielsweise die „exertional desaturation“ in der frühen Rekonvaleszenzphase werden in der akuten Phase der Frührehabilitation detektiert. Diskussion Mit neuen Herausforderungen an die Rehabilitation ist nach schweren COVID-19-Infektionen zu rechnen, sodass rehabilitative Behandlungsansätze bei einer fachübergreifenden Frührehabilitation im Akutkrankenhaus dringend erforderlich sind. Nicht zuletzt sichert die Akutrehabilitation nicht nur eine nahtlose Behandlungskette, sondern auch den Abstrom von der Intensivstation zur Sicherung lokaler Strukturen.