A Comparison of Early Rehabilitation in the Intensive Care Units of Patients With Severe COVID-19: A Propensity Score Matching Analysis.

Aim This study aimed to investigate early rehabilitation in the intensive care unit (ICU) for patients with severe coronavirus disease 2019 (COVID-19) who require mechanical ventilation Methods Twenty patients with severe COVID-19 (COVID-19 group) who were admitted to the ICU between April 2020 and March 2022 were included. For the control (non-COVID-19) group, 20 individuals were selected among ICU patients admitted between April 2018 and March 2020. The controls were propensity score-matched by age, sex, and Sequential Organ Failure Assessment (SOFA) score. Results In the COVID-19 group, the percentage of extubated patients was significantly higher. Furthermore, mechanical ventilation and lengths of ICU stay were also significantly longer. There were no significant differences in discharge outcomes or mortality, but there was a significant difference in the number of muscle relaxants and steroid treatments utilized with the COVID-19 group, requiring more of these medications. The percentage of patients who achieved sitting on the edge of a bed was also significantly higher in the COVID-19 group, but the days between the first rehabilitation and first sitting were significantly greater in this group. Conclusion Early rehabilitation of patients with COVID-19 may be an effective measure to promote recovery. However, continued investigation is warranted.

[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.

Effectiveness of Early Combined Rehabilitation in COVID-19 Related ARDS Patients After the Successfull Application of Extracorporeal Membrane Oxygenation: Two Case Reports

Many cardiac, pulmonary, and psychiatric complications occur due to long-term bed rest, infection, and critical illness neuropathy/myopathy in extra-corporeal membrane oxygenation (ECMO) applied coronavirus disease-2019 (COVID-19) inpatients in intensive care units. Physiotherapy plays an important role in restoring physical functions in the subacute phase following ECMO decannulation. After being discharged, and with combined rehabilitation, these patients experience a faster recovery and their quality of life increases. In this article, the effects of the combined physiotherapy program, which was applied to two patients with COVID-19 who received ECMO treatment and were discharged from the intensive care unit, is discussed. Early application of the combined rehabilitation program after discharge resulted in a positive outcome. (English) [ FROM AUTHOR] Yoğun bakım ünitelerinde yatan ve ekstra-korporeal membran oksijenasyonu (ECMO) uygulanan koronavirüs hastalığı-2019 (COVÍD-19) hastalarında uzun süreli yatak istirahati, enfeksiyon ve kritik hastalık nöropatisi/miyopatisi nedeniyle birçok kardiyak, pulmoner ve psikiyatrik komplikasyon ortaya çıkmaktadır. Fizyoterapi, ECMO dekanülasyonunu takiben subakut fazda fiziksel fonksiyonların eski haline getirilmesinde önemli bir rol oynamaktadır. Taburcu olduktan sonra, bu hastalar kombine rehabilitasyon ile daha hızlı iyileşmekte ve yaşam kaliteleri artmaktadır. Bu yazıda, ECMO tedavisi gören ve yoğun bakım ünitesinden taburcu olan COVÍD-19’lu iki hastaya uygulanan kombine fizyoterapi programının etkileri tartışılmaktadır. Kombine rehabilitasyon programının taburcu olduktan sonra erken uygulanması olumlu sonuçlanmıştır. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

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.

A Design of Self-Assisted Patient Control Technique for Early Rehabilitation Interventions to Prevent the Reduced elbow Joint ROM of COVID-19 Patients

The novel coronavirus, SARS-CoV-2 pandemic has posed new challenges for physiotherapist due to unprecedented acute care patients' surge. It contributed to minimize physical activity, especially reducing the elbow range of motion (ROM). Early rehabilitation and physiotherapy are recommended to combat the adverse effects of extended immobility. However, the increased patient-physiotherapist interaction increased risks of disease transmission. There emerges a need to minimize this interaction and disease transmission probability. This study aims to speed-up the return to regular ROM of COVID-19 patients by developing a self-assisted device for successful elbow therapy. The proposed device referred as 'self-assisted', reflects the idea of active and passive patient intervention and early rehabilitation. The device is designed and programmed to characterize the patients into three levels, depending on their ROM vulnerability: level 1 below 50 degrees, level 2 50 degrees-100 degrees and level 3 above 100 degrees. To examine the efficacy and accuracy of SAPT-COVID-19, eight volunteers with varying ages were selected, who were home-bound due to prolong COVID-19 pandemic and compromised their functional ROM. SAPT-COVID-19 substantially strengthened the elbow ROM for the volunteers and hit the maximum functional ROM over 14 -days exercise session, resulting in approximately 10 improvement in elbow ROM The degree of efficiency of active and passive exercise has also been widely examined. SAPT-COVID-19 is supposed to prevent elbow ROM deterioration and reduce hospitalization, with therapeutic and economic gain and minimized the physiotherapist-patient interactions.

[The specificities of the interventions of physiotherapists in intensive care]. / Les spécificités des interventions des masseurs-kinésithérapeutes en réanimation.

The intervention of physiotherapists in the intensive care unit allows the optimisation of the care project through the assessment and management of the motor, respiratory and swallowing functions of patients. If COVID-19 has only slightly modified the practice of these professionals, the impact of the pandemic on intensive care units has reinforced the added value of their care.

Early rehabilitation after lung transplantation with extracorporeal membrane oxygenation (ECMO) of COVID-19 patient: a case report.

Even when severe acute respiratory syndrome coronavirus 2-related coronavirus disease 2019 (COVID-19) is treated with first-line drugs, it progresses and leads to irreversible loss of lung function in some critically ill patients, and lung transplantation is an effective treatment for end-stage chronic pulmonary disease. This case report mainly describes the rehabilitation of a 66-year-old female patient with severe COVID-19 after bilateral lung transplantation. The old patient had a body mass index of 31.2 kg/m2. She underwent bilateral lung transplantation due to severe and irreversible injury of both lungs. Long-term mechanical ventilation and extracorporeal membrane oxygenation (ECMO) treatment and preoperative and postoperative high-dose corticosteroid therapy and due to the size of the donor lung does not match the size of the recipient's diseased lung, and the right middle lobe of the graft is removed before transplantation. Weaning from the ventilator failed due to weak neuromuscular drive, and muscle strength. A full, personalized pulmonary rehabilitation program was initiated with the help of the physical therapists, the respiratory therapy, the doctors, the nurses and psychotherapist team based on the functional levels. The rehabilitation intervention was conducted on postoperative day 4, This included posture management, airway clearance techniques, respiratory training, muscle strength training, transfer training, daily therapeutic bronchoscopy and psychological support. The ECMO was removed successfully on the fifth day. the patient's physical function, muscle strength and the quality of life has been improved. The good prognosis after rehabilitation indicates that early rehabilitation intervention is effective and feasible and safety for patients after lung transplantation.

Intensive Care Admission and Early Neuro-Rehabilitation. Lessons for COVID-19?

Coronavirus disease 2019 (COVID-19) requires admission to intensive care (ICU) for the management of acute respiratory distress syndrome in about 5% of cases. Although our understanding of COVID-19 is still incomplete, a growing body of evidence is indicating potential direct deleterious effects on the central and peripheral nervous systems. Indeed, complex and long-lasting physical, cognitive, and functional impairments have often been observed after COVID-19. Early (defined as during and immediately after ICU discharge) rehabilitative interventions are fundamental for reducing the neurological burden of a disease that already heavily affects lung function with pulmonary fibrosis as a possible long-term consequence. In addition, ameliorating neuromuscular weakness with early rehabilitation would improve the efficiency of respiratory function as respiratory muscle atrophy worsens lung capacity. This review briefly summarizes the polymorphic burden of COVID-19 and addresses possible early interventions that could minimize the neurological and systemic impact. In fact, the benefits of early multidisciplinary rehabilitation after an ICU stay have been shown to be advantageous in several clinical conditions making an early rehabilitative approach generalizable and desirable to physicians from a wide range of different specialties.