hysiotherapy intervention in a patient with COVID-19 post extubation: A case report
Ofer Rockman-Romano1,2, Gilad Sorek1,2,3, Hadas Ofek2
1 Padeh-Poriya medical center
2 Physical Therapy department, Zefat academic college
3 Physical Therapy department, Tel Aviv University
Background: It has been declared that the SARS-COV-2 virus, which causes the Coronavirus disease (COVID-19), has generated a pandemic. The first critical patient in Israel was admitted with pneumonia and treated for Acute Respiratory Distress Syndrome (ARDS) with mechanical ventilation. After approximately one week he was extubated and required physiotherapy (PT) for respiratory and functional rehabilitation. Since no clinical guidelines for physiotherapy of Corona patients had been provided at the time of admission, the treatment was based on prior knowledge of PT interventions in ARDS and pneumonia, and on symptoms and signs indications evident upon examination.
Objectives: To describe the PT treatment in a critically ill Corona patient who had been extubated after mechanical ventilation.
Methods: The case report was written using the Subjective, Objective, Assessment, Plan (SOAP) model, and the treatment goals were set using the Specific, Measurable, Achievable, Realistic/Relevant, Timed (SMART) model.
Case description: A 38 year old male, generally healthy and a heavy smoker, presented at the hospital five days after initial symptoms, with deterioration in his condition, which involved a fever. He was found positive for COVID-19 and admitted to the isolation ward. Following a further deterioration he was treated with mechanical ventilation. A week later he was extubated and required physiotherapy. In the first few days, PT was delivered in the isolation room, with the outside support of an additional therapist using technological means, and further on by remote patient guidance. Treatment goals included reduced work of breathing and secretion clearance, as well as achieving functional independence including bed mobilization, transfers, and walking. The goals were fully achieved in six days of treatment, when the patient was capable of walking in the ward independently with no distance limitations and no shortness of breath or increased secretions.
Discussion and conclusions: Among the considerations involved in decisions concerning the treatment of a critically ill patient with Covid-19, is the necessity to take into account minimization of the treating staff’s physical exposure to Corona patients and use of technological means for remote guidance. In retrospect, it appears that we operated in agreement with subsequently published Israeli and global clinical guidelines.
Keywords: Physiotherapy, COVID-19, Coronavirus, ARDS, Pneumonia, Extubation, Isolation