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Pulmonology ; 2020 Sep 06.
Article in English | MEDLINE | ID: covidwho-745949
Monaldi Arch Chest Dis ; 90(2)2020 Jun 23.
Article in English | MEDLINE | ID: covidwho-688266


There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts' opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision making within the context of the individual patient. Further studies will evaluate the clinical usefulness of these suggestions.

Coronavirus Infections/rehabilitation , Physical Therapy Modalities , Pneumonia, Viral/rehabilitation , Respiratory Insufficiency/rehabilitation , Respiratory Therapy/methods , Ambulatory Care , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Delphi Technique , Exercise Test , Humans , Intensive Care Units , Italy , Nutritional Status , Pandemics , Personal Protective Equipment , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Quality of Life , Respiratory Function Tests , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Stress Disorders, Post-Traumatic
Respiration ; 99(6): 493-499, 2020.
Article in English | MEDLINE | ID: covidwho-324614


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.

Betacoronavirus , Coronavirus Infections/complications , Physical Therapy Modalities , Pneumonia, Viral/complications , Respiratory Insufficiency/rehabilitation , Coronavirus Infections/epidemiology , Humans , Italy , Pandemics , Patient Acuity , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/etiology , Respiratory Distress Syndrome, Adult/rehabilitation , Respiratory Insufficiency/etiology
Monaldi Arch Chest Dis ; 90(2)2020 May 19.
Article in English | MEDLINE | ID: covidwho-324230


Due to COVID-19 outbreak, to lighten the burden of acute and critical care hospitals, some respiratory rehabilitation departments have been used to host patients with COVID-19 in the post-acute phase. This new and unexpected situation required a change of roles and scheduling of the rehabilitation teams. In this manuscript we describe the unexpected and urgent organizational change of the Cardio-Pulmonary Rehabilitation (CPR) service during the COVID-19 emergency in a Northern Italian rehabilitation hospital, focusing on the Respiratory Physiotherapists' (RPTs) role. A quick three-days complete reorganization of the entire hospital was needed. A COVID-19 care team including a multidisciplinary panel of physicians, nurses, and RPTs was quickly performed to manage 90 beds for post acute patients with COVID-19. Within the team, the RPTs changed their shifts, so as to be available 16h per day, 7 days out of 7. Remodelled tasks in charge of RPTs were: oxygen therapy daily monitoring, non invasive ventilation (NIV) and continuous positive airways pressure (CPAP) delivery, pronation and postural changes to improve oxygenation, reconditioning with leg/arm cranking and exercises, initial and final patients' functional assessment by short-physical performance battery (SPPB) and 1-minute sit-to-stand test (1-STS) to evaluate motor conditions and exercise-induced oxygen desaturation. Three "what-to-do" algorithms were developed to guide: i) oxygen de-escalation by reducing inhaled fraction of oxygen (FiO2); ii) oxygenation improvement through the use of Venturi mask; iii) reconditioning and physical activity. One-hundred seventy patients were treated in one month. As main topics, RPTs have been involved in oxygen therapy management in almost a third of the admitted patients, reconditioning exercises in 60% of the cases, and initial and final functional motor capacity assessment in all patients. Details of activities performed by the RPT in one typical working day are also shown. Our reorganization has exploited the professional skills and clinical expertise of the RPTs. This re-organization can provide practical insights to other facilities that are facing this crisis, and may be a starting point for implementing post-COVID-19 rehabilitation. Future studies will have to improve and review this organization.

Betacoronavirus , Coronavirus Infections/rehabilitation , Pneumonia, Viral/rehabilitation , Respiratory Insufficiency/rehabilitation , Respiratory Therapy/methods , Continuous Positive Airway Pressure , Coronavirus Infections/complications , Humans , Italy , Noninvasive Ventilation , Pandemics , Physical Therapy Modalities , Pneumonia, Viral/complications , Respiration, Artificial , Respiratory Insufficiency/therapy , Respiratory Therapy/trends