Immediate effect of therapeutic positioning and breathing exercises on oxygen saturation in critically ill non-intubated COVID-19 patients: A retrospective study

Background: COVID-19 presents with symptoms of fever, headache, dry cough, and dyspnea. Acute hypoxemic respiratory failure is the most common complication occurring in 60%–70% of patients admitted to the intensive care unit (ICU). Positioning and breathing exercise formed the mainstay of physiotherapy intervention in patients admitted to COVID ICU. This was primarily aimed at reducing the ventilation/perfusion mismatch. The aim of this study was to retrospectively analyze the immediate effect of breathing exercise and positioning on oxygen saturation (SpO2). Materials and Methods: The available data of COVID-19 patients admitted to an ICU of a tertiary care hospital in Mumbai from June 5 to July 5, 2020 were retrospectively analyzed. Demographics and mode of oxygen delivery were noted. Changes in SpO2 after positioning and breathing exercises during a single session of treatment were analyzed using Wilcoxon paired signed-rank test with a level of significance at P < 0.05. Results: There was a statistically significant improvement in SpO2 after breathing exercises and prone positioning in all patients on oxygen supplementation. Side-lying positioning showed an improvement in oxygen saturation in patients who were on non-invasive ventilation and facemask. Conclusion: Both breathing exercises and positioning show an immediate improvement in oxygen saturation in patients with COVID-19.

Physiotherapy in the Covid ward: Where compassion overcomes fear.

The narrative is an account of the personal experience of a cardiopulmonary physiotherapist inside the Covid ICU, when the city of Mumbai was brought to a standstill. It describes the need to seek an opportunity to face the challenges, guided by intuition and one's skill set to help those fighting to survive Covid. Facing a new and complex disease meant having to create guidelines for treatment, overcome the patients' despair, and even cope with the cumbersome protective gear. But the gradual improvement in patients' health and their joy on recovering inspired us to put in more effort with unity ,dedication and will power, standing together to face the pandemic, enabling us to realise what is required of us, now and in the future - striving to better ourselves in the science of health each day.

Beyond COVID-19: Evidence-Based Consensus Statement on the Role of Physiotherapy in Pulmonary Rehabilitation in the Indian Context.

Post COVID-19 sequelae includes breathlessness, weakness, fatigue, decreased exercise tolerance and impaired quality of life. Physiotherapy based rehabilitation program is an essential component for post COVID-19 patients in facilitating maximum functional recovery. Expert consensus statements are available from the developed countries. There is a need for a guidelines to manage post COVID-19 sequelae in Indian context. The objective of this consensus statement is to provide evidence informed guidelines for post COVID-19 physiotherapy management as a component of pulmonary rehabilitation. This consensus statement was developed by expert panel across India. Published literatures were appraised and used to prepare the recommendations. This is the first of its kind of work providing preliminary guidelines for post COVID-19 physiotherapy.

Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup.

BACKGROUND: With the Wuhan pandemic spread to India, more than lakhs of population were affected with COVID-19 with varying severities. Physiotherapists participated as frontline workers to contribute to management of patients in COVID-19 in reducing morbidity of these patients and aiding them to road to recovery. With infrastructure and patient characteristics different from the West and lack of adequate evidence to existing practices, there was a need to formulate a national consensus. MATERIALS AND METHODS: Recommendations were formulated with a systematic literature search and feedback of physiotherapist experiences. Expert consensus was obtained using a modified Delphi method. RESULTS: The intraclass coefficient of agreement between the experts was 0.994, significant at p < 0.001. CONCLUSION: This document offers physiotherapy evidence-based consensus and recommendation to planning physiotherapy workforce, assessment, chest physiotherapy, early mobilization, preparation for discharge planning, and safety for patients and therapist in acutec are COVID 19 setup of India. The recommendations have been integrated in the algorithm and are intended to use by all physiotherapists and other stakeholders in management of patients with COVID-19 in acute care settings. HOW TO CITE THIS ARTICLE: Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, et al. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020;24(10):905-913.

Preliminary Observations and Experiences of Physiotherapy Practice in Acute Care Setup of COVID 19: A Retrospective Observational Study.

BACKGROUND: The rapid outbreak of coronavirus disease 2019 (COVID-19), a public health emergency of grave concern, warranted hospital admissions with almost 90,000 cases in June 2020 in city of Mumbai. 3-10% of the patients with moderate to severe involvement required intensive care unit (ICU) admission with respiratory support. Patients admitted in ICU with an acute COVID event present with respiratory dysfunction and are more likely to have critical illness myopathy and neuropathy (CIMN). Physiotherapy services being integral part of non-pharmacological management of any ICU was implemented for patients with COVID 19; a novel viral disease. OBJECTIVE: This retrospective study was undertaken to explore the physiotherapy practices that could be implemented in patients admitted with COVID 19 in the ICU and its effect on mobility and oxygen requirement as an outcome. METHODOLOGY: Following ethical permission of institute, the data was extracted from electronic data record sheet in which daily parameters for physiotherapy intervention were recorded. Data from a single ICU and step down unit (SDU) from 5th June to 5th July 2020 was analysed. Records of patients diagnosed with COVID 19 and admitted in ICU or SDU were studied. Those in the age group of 18 to 90 years, of either gender were included. Demographic characteristics, disease severity, oxygen requirement, mobility status, physiotherapy intervention were studied. RESULTS: 278 record sheets (110 ICU and 168 SDU) were retrospectively analysed for demographics. 44.55% of patients improved with side lying position, 37.27% with prone position and 10.91% with quarter prone position. 4.55% of patient maintained oxygenation in propped up sitting. 2.73% could not be positioned. Chest physiotherapy techniques applied were deep breathing, ACBT, paced breathing and diaphragmatic breathing. Deep intercostal pressure on NIV along with vibrations was given to 12.72% of patients in the ICU. Group therapy sessions were conducted in SDU where 50.59% patients participated. ICU mobility score showed significant improvement on Wilcoxon Signed Ranks test status on day 7 in the ICU (z=-5.99, p=0.00) and SDU (z= 7.676, p=0.00) compared to day 1. Descriptive analysis showed a definitive reduction in oxygen support requirement. CONCLUSION: Most common form of physiotherapy interventions in patients with Covid 19 were therapeutic positioning, early mobilization and breathing exercises. Physiotherapy intervention appears promising in facilitating early patient ambulation and discharge. This study shows that it is safe and feasible to provide early physiotherapy treatment techniques in patients with COVID-19 using appropriate measures of infection prevention and cross contamination.