Covid-19 Rehabilitation Therapy: A novel strategy to reduce Covid-19 respiratory complications and significantly improve lung function.

ABSTRACT

Navi Mumbai Municipal Corporation, Covid-19 DCHC and ICU, Navi Mumbai COVID- 19 pandemic has become a leading cause of morbidity and mortality worldwide since the emergence of novel coronavirus SARS-CoV-2 in December 2019. The patterns of imaging abnormalities and data from prior coronavirus outbreaks suggest that patients with severe COVID-19pneumonia are at increased risk of progression to interstitial lung disease and chronic pulmonary vascular disease.We have devised an effective,inexpensive approach for Covid-19 recovering patients to reduce the incidence and severity of these pulmonary complications. MATERIAL: This cross sectional study was conducted across two centres-largest government-run DCHC,Vashi, Navi Mumbai and private tertiary care hospital in Airoli, Navi Mumbai from Nov'20 to Feb'21. IEC approval, consent was obtained.472 patients were enrolled. Demographic,clinical,radiological data was collected.Adults >18yrs who tested Covid-19 RTPCR/ Rapid Antigen Positive, HRCTSS of >10, required home oxygen of 4lts/min and above, ABG established hypoxia,oxygen saturation of 82% to 94%RA, with/without existing comorbidities were included in the study.Covid Rehabilitation Therapy included six alternate day OPD based sessions over twelve days starting three days after the day of discharge from the hospital.Each session included clinical assessment,15 minute intensive chest physiotherapy and breathing exercises followed by 6 minutes of nebulisation with Levosalbutamol+Ipratropium bromide and Budesonide,followed by high flow humidified oxygen therapy of 10lts/min via non breathable mask for 90 minutes along with breathing variation of inhalationexhalation of 12. Oxygen Saturation, Pulse,BP, RR were established at the beginning of every session and the end of the session.6MWT,Chest Xray was obtained at first and sixth session.These factors were used to determine outcome measures in Covid Rehabilitation Therapy. OBSERVATION Of 472patients, 218(46.2%) were females, 254(53.8%) were males, 179(38%) had baseline saturation 82-85% on RA, 186(40%) had 85-90%, 107(22.6%) had 90-94% RA. 78% have improved to saturation of 98% at the end of last session of therapy,8%improved to 97%,10% to 96%,4% to 95%. 354(75%) patients showed 3/4th resolution of fibrosis on Chest Xray, 70(14.8%) showed 1/2 resolution,48(10.2%) have 1/4 resolution on CXR. 82% patients showed complete normalcy on 6MWT,15% showed partial improvement and 3% have showed no change.82% patients were able to come off home oxygen within 4 days,12% within 10 days and 6% within 21 days of completing therapy.369 patients reported significant reduction in dyspnea,chest pain.The results of therapy are remarkable and we had 0 defaulters.These patients as compared to the ones who didn't opt for the therapy did not have any complications after 1month on follow up versus those who presented with intermittent dyspnea and fatiguability after one month of Covid. CONCLUSION: Covid-19 Rehabilitation Therapy is cost effective,easy and convenient approach to reduce and prevent related pulmonary complications and must be advocated.