Subject(s)
Emergency Medical Services , Noble Gases/pharmacology , Post-Cardiac Arrest Syndrome/drug therapy , Respiratory Therapy/methods , Animals , Argon/pharmacology , Argon/therapeutic use , Carbon Monoxide/pharmacology , Carbon Monoxide/therapeutic use , Disease Models, Animal , Emergency Medical Services/methods , Emergency Medical Services/standards , Helium/pharmacology , Helium/therapeutic use , Humans , Hydrogen/pharmacology , Hydrogen/therapeutic use , Hydrogen Sulfide/pharmacology , Hydrogen Sulfide/therapeutic use , Nitric Oxide/pharmacology , Nitric Oxide/therapeutic use , Noble Gases/therapeutic use , Post-Cardiac Arrest Syndrome/physiopathology , Respiratory Therapy/standards , Respiratory Therapy/statistics & numerical data , Xenon/pharmacology , Xenon/therapeutic useABSTRACT
The German Respiratory Society (DGP) has commissioned Assembly 12 "Rehabilitation, Prevention and Tobacco Control" to develop recommendations for the implementation of pulmonary rehabilitation in COVID-19 patients. This position paper is based on the current state of knowledge, which develops daily. This position paper describes the health consequences in COVID-19 as well as the indications for pulmonary rehabilitation. Rehabilitative therapies in COVID-19 are already indicated on the ward or intensive care unit, continue as early pulmonary rehabilitation in the acute hospital and as pulmonary rehabilitation in pulmonary rehabilitation centers. The main focus of this position paper is to propose recommendations for the content-related implementation of a multimodal, interdisciplinary pulmonary rehabilitation in COVID-19 patients.
Subject(s)
Betacoronavirus , Coronavirus Infections/rehabilitation , Coronavirus Infections/therapy , Pneumonia, Viral/rehabilitation , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Respiratory Distress Syndrome/therapy , Respiratory Insufficiency/therapy , Respiratory Therapy/standards , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Humans , Lung/physiopathology , Lung/virology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome/etiology , Respiratory Insufficiency/prevention & control , SARS-CoV-2 , Societies, MedicalABSTRACT
The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic shows a rapid increase in cases and deaths. The World Health Organization (WHO) has shown that more than 200.000 confirmed cases have been identified in more than 166 countries/territories. Public health authorities in Brasil have reported 532 confirmed cases by March 19. Approximately 5% of the patients will require intensive care unit treatment with oxygen therapy and mechanical ventilation. Limited data are available about rehabilitation protocols for severe illness and intensive care treatment of COVID-19 increase. Thus, we aim to show current information about COVID-19, describing symptoms and the respiratory management for critical patients and preventive care. Physical therapists and all health care professionals need to recognize the challenges they will face in the coming months.
Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Physical Therapists/standards , Physical Therapy Modalities/standards , Pneumonia, Viral/therapy , Brazil , COVID-19 , Coronavirus Infections/physiopathology , Coronavirus Infections/prevention & control , Critical Care/standards , Humans , Pandemics/prevention & control , Pneumonia, Viral/physiopathology , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic/standards , Respiratory Distress Syndrome/therapy , Respiratory Therapy/standards , SARS-CoV-2ABSTRACT
Background: The COVID-19 pandemic has highlighted health care systems' vulnerabilities. Hospitals face increasing risk of periods of scarcity of life-sustaining resources such as ventilators for mechanical respiratory support, as has been the case in Italy as of March, 2020. The National Academy of Medicine has provided guidance on crisis standards of care, which call for the reallocation of scarce medical resources to those who will benefit most during extreme situations. Given that this will require a departure from the usual fiduciary duty of the bedside clinician, we determined and mapped potential barriers to the implementation of the guidelines from stakeholders using an implementation science framework. Methods: A protocol was created to operationalize national and state guidelines for triaging ventilators during crisis conditions. Focus groups and key informant interviews were conducted from July-September 2018 with clinicians at three acute care hospitals of an urban academic medical center. Respiratory therapists, intensivists, nursing leadership and the palliative care interdisciplinary team participated in focus groups. Key informant interviews were conducted with emergency management, respiratory therapy and emergency medicine. Subjects were presented the protocol and their reflections were elicited using a semi-structured interview guide. Data from transcripts and notes were categorized using a coding strategy based on the Theoretical Domains Framework. Results: Participants anticipated that implementing this protocol would challenge their roles and identities as clinicians including both their fiduciary duty to the patient and their decision-making autonomy. Despite this, many participants acknowledged the need for such a protocol to standardize care and minimize bias as well as to mitigate potential consequences for individual clinicians. Participants identified the question of considering patient quality of life in triage decisions as an important and unresolved ethical issue in disaster triage. Conclusion: Clinicians' discomfort with shifting roles and obligations could pose implementation barriers for crisis standards of care.
Subject(s)
Attitude of Health Personnel , Betacoronavirus , Coronavirus Infections/therapy , Critical Care/standards , Pneumonia, Viral/therapy , Standard of Care , Withholding Treatment/ethics , Academic Medical Centers , COVID-19 , Coronavirus Infections/epidemiology , Critical Care/ethics , Emergency Medicine/standards , Focus Groups , Humans , Interviews as Topic , Pandemics , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Quality of Life , Respiration, Artificial/standards , Respiratory Therapy/standards , SARS-CoV-2 , Standard of Care/ethics , Triage/methods , Triage/standardsABSTRACT
COVID-19 is a highly infectious respiratory infection disease, which leads to dysfunction of respiratory, physical, and psychological of the patients. pulmonary rehabilitation is an important intervention for clinical patients as well as cure patients. With the deeper cognition of COVID-19 and accumulation of clinical experience, we proposed the recommendations for pulmonary rehabilitation of COVID-19 in adults based on the opinions of front-line clinical experts involved in the management of this epidemic and a review of the relevant literature and evidences: (1)for the inpatients with COVID-19, pulmonary rehabilitation would relieve the symptoms of dyspnea, anxiety, and depression; eventually improve physical function and the quality of life; (2)For severe/critical inpatients, the early performance of pulmonary rehabilitation is not suggested. (3)For isolating patients, the pulmonary rehabilitation guidence should be conducted through education video, instruction manual or remote consultation. (4)Assessment and monitor should be performed throughout the entire pulmonary rehabilitation process.(5)Taking proper grading protection following the guideline. These recommendations can serve as a clinical practice guidence and basis for pulmonary rehabilitation of COVID-19.
Subject(s)
Coronavirus Infections/rehabilitation , Coronavirus Infections/therapy , Pneumonia, Viral/rehabilitation , Pneumonia, Viral/therapy , Respiratory Therapy/standards , Adult , Betacoronavirus , COVID-19 , Humans , Pandemics , Practice Guidelines as Topic , Quality of Life , SARS-CoV-2ABSTRACT
Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units.