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1.
Brain Inj ; 35(5): 520-529, 2021 04 16.
Article in English | MEDLINE | ID: covidwho-1080951

ABSTRACT

Purpose: SARS-CoV-2 infection can cause the coronavirus disease (COVID), ranging from flu-like symptoms to interstitial pneumonia. Mortality is high in COVID pneumonia and it is the highest among the frailest. COVID could be particularly serious in patients with severe acquired brain injury (SABI), such as those with a disorder of consciousness. We here describe a cohort of patients with a disorder of consciousness exposed to SARS-CoV-2 early after their SABI.Materials and methods: The full cohort of 11 patients with SABI hospitalized in March 2020 in the IRCCS Fondazione Don Gnocchi rehabilitation (Milan, Italy) was recruited. Participants received SARS-CoV-2 testing and different clinical and laboratory data were collected.Results: Six patients contracted SARS-CoV-2 and four of them developed the COVID. Of these, one patient had ground-glass opacities on the chest CT scan, while the remaining three developed consolidations. No patient died and the overall respiratory involvement was mild, requiring in the worst cases low-flow oxygen.Conclusions: Here we report the clinical course of a cohort of patients with SABI exposed to SARS-CoV-2. The infection spread among patients and caused COVID in some of them. Unexpectedly, COVID was moderate, caused at most mild respiratory distress and did not result in fatalities.


Subject(s)
Brain Injuries/complications , COVID-19/complications , Consciousness Disorders/complications , Brain Injuries/virology , COVID-19 Testing , Consciousness Disorders/virology , Humans , Italy
2.
Int J Rehabil Res ; 44(1): 77-81, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1075674

ABSTRACT

In this case series study, we aimed to evaluate the feasibility of a subacute rehabilitation program for mechanically ventilated patients with severe consequences of COVID-19 infection. Data were retrospectively collected from seven males (age 37-61 years) who were referred for inpatient rehabilitation following the stay in the ICU (14-22 days). On admission, six patients were still supported by mechanical ventilation. All patients were first placed in isolation in a special COVID unit for 6-22 days. Patients attended 11-24 treatment sessions for the duration of rehabilitation stay (13-27 days), including 6-20 sessions in the COVID unit. The treatment included pulmonary and physical rehabilitation. The initially nonventilated patient was discharged prematurely due to gallbladder problems, whereas all six mechanically ventilated patients were successfully weaned off before transfer to a COVID-free unit where they stayed for 7-19 days. At discharge, all patients increased limb muscle strength and thigh circumference, reduced activity-related dyspnea, regained functional independence and reported better quality of life. Rehabilitation plays a vital role in the recovery of seriously ill post-COVID-19 patients. Facilities should develop and implement plans for providing multidisciplinary rehabilitation treatments in various settings to recover functioning and prevent the development of long-term consequences of the COVID-19 disease.


Subject(s)
COVID-19/rehabilitation , Respiration, Artificial , Respiratory Distress Syndrome/rehabilitation , Adult , Feasibility Studies , Humans , Inpatients , Male , Middle Aged , Patient Discharge , Physical Therapy Modalities , Quality of Life , Respiratory Distress Syndrome/virology , Retrospective Studies , Ventilator Weaning
3.
J Cardiopulm Rehabil Prev ; 40(4): 205-208, 2020 07.
Article in English | MEDLINE | ID: covidwho-981439

ABSTRACT

DETAILS OF THE CLINICAL CASE: A 51-yr-old man underwent a respiratory rehabilitation program (RRP), after being tracheostomized and ventilated due to acute respiratory distress syndrome (ARDS) from coronavirus disease-2019 (COVID-19) infection. Respiratory care, early mobilization, and neuromuscular electrical stimulation were started in the ad hoc isolation ward of our rehabilitation center. At baseline, muscle function was consistent with intensive care unit-acquired weakness and the patient still needed mechanical ventilation (MV) and oxygen support. During the first week of RRP in isolation, the patient was successfully weaned from MV, the tracheal cannula was removed, and the walking capacity was recovered. At the end of the RRP, continued in a standard department, respiratory muscles strength increased by 7% and muscle function improved as indicated by the quadriceps size enlargement of 13% and the change of the Medical Research Council sum score from 48/60 to 58/60. DISCUSSION: Providing RRP in patients with severe COVID-19 ARDS involves risks for operators and organizational difficulties, especially in rehabilitation centers; nevertheless, its continuity is important to prevent the development of permanent disabilities in previously healthy subjects. Limited to the experience of only one patient, we were able to carry out a safe RRP during the COVID-19 pandemic, promoting the complete functional recovery of a COVID-19 young patient. SUMMARY: Most patients who develop serious consequences of COVID-19 infection risk a reduction in their quality of life. However, by organizing and directing specialized resources, subacute rehabilitation facilities could ensure the continuity of the RRPs even during the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Respiratory Distress Syndrome/rehabilitation , Respiratory Therapy/methods , Ventilator Weaning/methods , COVID-19 , Coronavirus Infections/diagnosis , Feasibility Studies , Humans , Male , Middle Aged , Pandemics , Patient Isolation , Pneumonia, Viral/diagnosis , Recovery of Function , Rehabilitation Centers , Respiration, Artificial/methods , Respiratory Distress Syndrome/virology , Respiratory Function Tests , Risk Assessment , Severity of Illness Index , Tracheostomy/methods , Treatment Outcome
4.
Eur J Phys Rehabil Med ; 56(3): 319-322, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-42122

ABSTRACT

This paper reports the immediate impact of the epidemic on rehabilitation services in Italy, the first country in Europe hit by COVID-19. In a country with almost 5000 Physical and Rehabilitation Medicine physicians, the webinar had 230 live viewers (4.5%), and more than 8900 individual visualizations of the recorded version. The overall inadequate preparation of the rehabilitation system to face a sudden epidemic was clear, and similar to that of the acute services. The original idea of confining the COVID-19 cases to some areas of rehabilitation wards and/or hospitals, preserving others, proved not to be feasible. Continuous reorganization and adaptation were required due to the rapid changes. Overall, rehabilitation needs had to surrender to the more acute emergency, with total conversion of beds, wards and even hospitals. The quarantine needs heavily involved also outpatient services that were mostly closed. Rehabilitation professionals needed support, but also acted properly, again similarly to what happened in the acute wards. The typical needs of rehabilitation, such as human and physical contacts, but also social interactions including patient, team, family and caregivers, appeared clearly in the current unavoidable need of being suppressed. These notes could serve the preparation of other services worldwide.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/rehabilitation , Physical and Rehabilitation Medicine/organization & administration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/rehabilitation , COVID-19 , Coronavirus Infections/prevention & control , Humans , Italy/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , SARS-CoV-2
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