ABSTRACT
Introduction: The coronavirus disease-2019 (COVID-19) is a highly contagious respiratory viral disease for both the general population and healthcare professionals caring for infected patients. Of particular concern is the potential for significant respiratory, cardiovascular, physical, and psychological dysfunctions.Areas covered: In this context, the current review will focus on the following areas: 1) staying physically active during the COVID-19 pandemic; 2) highlighting the importance of understanding COVID-19 mechanisms; 3) preventing infections for healthcare workers by using personal protective equipment; 4) highlighting importance of respiratory care and physical therapy during hospitalization in patients with COVID-19; and 5) facilitating referral to a rehabilitation program in patients recovering from COVID-19.Expert opinion: We recommend daily physical exercise, outdoors or at home, as physical exercise increases the synthesis of anti-inflammatory cytokines; Patients with COVID-19 may develop severe acute respiratory syndrome, hypoxemia, diffuse alveolar damage, ACE2 reduction in the cardiovascular system and muscle weakness acquired through a prolonged hospital stay; The role of the physiotherapist in the hospital environment is of fundamental importance-early mobilization is highly recommended in severe cases of COVID-19.
Subject(s)
COVID-19 , Exercise Therapy , Life Style , Pandemics , Rehabilitation/organization & administration , Exercise , Health Personnel , HumansABSTRACT
Introdução: Com o início da pandemia, inquietações quanto à condução da parada cardiorrespiratória em casos suspeitos e confirmados da COVID-19 surgiram ante as peculiaridades e publicações científicas quanto à temática. Dessa forma, o presente estudo apresenta uma reflexão e demonstra as novas recomendações acerca dos cuidados necessários a serem adotados pela equipe multiprofissional. Método: Trata-se de um estudo de reflexão teórica, de caráter descritivo e abordagem qualitativa com base em documentos convencionais e não convencionais emitidos pelos principais órgãos reguladores e revistas de grande impacto que abordam as temáticas discorridas. Além disso, não houve recorte temporal para a seleção do referencial bibliográfico. Resultados: Os resultados expostos abordaram o cuidado relacionado com os recursos humanos e materiais envolvendo a temática, o manejo da via aérea nesse evento em pacientes que estavam ou não em uso de intubação endotraqueal, assim como em relação aos indivíduos em posição prona. Conclusão e implicações para a prática: Diante das discussões apresentadas, é evidente a necessidade de atualização por parte das instituições de saúde em suas rotinas e dos profissionais que se encontram neste estudo como mecanismo de proteção e manutenção da qualidade do cuidado prestado Introduction: With the onset of the pandemic, concerns emerged about the management of cardiorespiratory arrest in suspected and confirmed cases of COVID-19 considering its singularities and scientific publications on the subject. Thus, this study presents a reflection about the new recommendations for patient care that must be adopted by multiprofessional teams. Method: This is a theoretical qualitative descriptive study that analyzed conventional and unconventional documents issued by the main regulatory bodies and high impact magazines addressing the study topics. No time frame was considered when selecting the bibliographic references. Results: The results addressed patient care with human and material resources involving the theme, the airway management in patients affected by COVID-19, whether they were using endotracheal intubation or not, and the approach for individuals in prone position. Conclusion and implications for the practice: In view of the discussions presented, health institutions and professionals must update their routines as a mechanism to protect and maintain the quality of care provided Introducción: Con el inicio de la pandemia, preocupaciones sobre la conducción del paro cardiorrespiratorio en casos sospechosos y confirmados de COVID-19 ante las peculiaridades y publicaciones científicas sobre el tema. Así pues, este estudio presenta una reflexión y demuestra las nuevas recomendaciones sobre los cuidados que deben adoptarse por el equipo. Método: Se trata de un estudio de reflexión teórica, de carácter descriptivo y enfoque cualitativo, basado em documentos convencionales y no convencionales emitidos por los principales organismos reguladores y revistas de alto impacto que abordan los temas tratados. Además, no hubo un recorte temporal para la selección de la referencia bibliográfica. Resultados: Los resultados expuestos abordaron el cuidado relacionado con los recursos humanos y materiales involucrando la temática, el manejo de la vía aérea en este evento, en pacientes que usaban o no intubación endotraqueal, como también en relación de individuos en posición prona. Conclusión e implicaciones para la práctica: Ante las discusiones presentadas, es evidente la necesidad de actualización por las instituciones de salud en sus rutinas y de los profesionales que se encuentran en este estudio, como mecanismo de protección y mantenimiento de la calidad del cuidado ministrado
ABSTRACT
In December 2019, a striking appearance of new cases of viral pneumonia in Wuhan led to the detection of a novel coronavirus (SARS-CoV2). By analyzing patients with severe manifestations, it became apparent that 20 to 35% of patients who died had preexisting cardiovascular disease. This finding warrants the important need to discuss the influence of SARS-CoV2 infection on the cardiovascular system and hemodynamics in the context of clinical management, particularly during mechanical ventilation. The SARS-CoV2 enters human cells through the spike protein binding to angiotensin-converting enzyme 2 (ACE2), which is important to cardiovascular modulation and endothelial signaling. As ACE2 is highly expressed in lung tissue, patients have been progressing to acute respiratory injury at an alarming frequency during the Coronavirus Disease (COVID-19) pandemic. Moreover, COVID-19 leads to high D-dimer levels and prothrombin time, which indicates a substantial coagulation disorder. It seems that an overwhelming inflammatory and thrombogenic condition is responsible for a mismatching of ventilation and perfusion, with a somewhat near-normal static lung compliance, which describes two types of pulmonary conditions. As such, positive pressure during invasive mechanical ventilation (IMV) must be applied with caution. The authors of this review appeal to the necessity of paying closer attention to assess microhemodynamic repercussion, by monitoring central venous oxygen saturation during strategies of IMV. It is well known that a severe respiratory infection and a scattered inflammatory process can cause non-ischemic myocardial injury, including progression to myocarditis. Early strategies that guide clinical decisions can be lifesaving and prevent extended myocardial damage. Moreover, cardiopulmonary failure refractory to standard treatment may necessitate the use of extreme therapeutic strategies, such as extracorporeal membrane oxygenation.
ABSTRACT
In December 2019, a striking appearance of new cases of viral pneumonia in Wuhan led to the detection of a novel coronavirus (SARS-CoV2). By analyzing patients with severe manifestations, it became apparent that 20 to 35% of patients who died had preexisting cardiovascular disease. This finding warrants the important need to discuss the influence of SARS-CoV2 infection on the cardiovascular system and hemodynamics in the context of clinical management, particularly during mechanical ventilation. The SARS-CoV2 enters human cells through the spike protein binding to angiotensin-converting enzyme 2 (ACE2), which is important to cardiovascular modulation and endothelial signaling. As ACE2 is highly expressed in lung tissue, patients have been progressing to acute respiratory injury at an alarming frequency during the Coronavirus Disease (COVID-19) pandemic. Moreover, COVID-19 leads to high D-dimer levels and prothrombin time, which indicates a substantial coagulation disorder. It seems that an overwhelming inflammatory and thrombogenic condition is responsible for a mismatching of ventilation and perfusion, with a somewhat near-normal static lung compliance, which describes two types of pulmonary conditions. As such, positive pressure during invasive mechanical ventilation (IMV) must be applied with caution. The authors of this review appeal to the necessity of paying closer attention to assess microhemodynamic repercussion, by monitoring central venous oxygen saturation during strategies of IMV. It is well known that a severe respiratory infection and a scattered inflammatory process can cause non-ischemic myocardial injury, including progression to myocarditis. Early strategies that guide clinical decisions can be lifesaving and prevent extended myocardial damage. Moreover, cardiopulmonary failure refractory to standard treatment may necessitate the use of extreme therapeutic strategies, such as extracorporeal membrane oxygenation.