Rehabilitation Needs of Patients with Covid-19 in Acute Phase

    Publication Date
    Source Authors
    Source Title
    Source Issue
    Publication Date

    2020

    Source Authors

    Marina Garofano, Matteo Maria Ascoli, Roberta Palumbo, Mariaconsiglia Calabrese

    Source Title

    Rehabilitation Needs of Patients with Covid-19 in Acute Phase

    Source Issue

    Rehabilitation Needs of Patients with Covid-19 in Acute Phase

    5

    Page Range: 437-441

    L’articolo nasce al fine di ricercare evidenze sull’intervento fisioterapico indirizzato ai pazienti affetti da COVID-19 ricoverati in terapia intensiva. La COVID-19 (Coronavirus Disease 19) è un’infezione virale causata dall’agente eziologico SARS-Cov-2 che colpisce principalmente il tratto respiratorio inferiore e provoca una serie di sintomi descritti come simil-influenzali, tra cui febbre, tosse, respiro corto, dolore ai muscoli e stanchezza. Una quota di pazienti va incontro a gravi complicanze di tipo respiratorio che nel 10% dei casi richiedono il ricovero in terapia intensiva. L’articolo è una revisione narrativa della letteratura, e ha previsto la consultazione delle maggiori banche al fine di analizzare il ruolo del fisioterapista in terapia intensiva, nella gestione della NIV (Non Invasive Ventilation) e relativamente al rischio di infezione per il fisioterapista stesso durante l’impiego di procedure che producono aerosol. Il ruolo del fisioterapista nelle unità di terapia intensiva consiste nel migliorare la capacità funzionale complessiva del paziente, di ripristinare l’autonomia respiratoria e oltre che la tolleranza alla sforzo riducendo così i rischi di complicanze associate all’allettamento prolungato.

    • Tra i possibili interventi riabilitativi realizzabili nelle unità di terapia intensiva respiratoria ricordiamo: posizionamento, considerato un vero e proprio trattamento, viene utilizzato con l’obiettivo di migliorare il rapporto ventilazione / perfusione (V0/Q0), i volumi polmonari e la funzione mucociliare, per ridurre il lavoro respiratorio e cardiaco;
    • esercizi di mobilizzazione attiva/passiva che hanno un significativo effetto sullo stato funzionale, sulla forza muscolare, sulla durata della ventilazione meccanica, sulla capacità di deambulare e sulla qualità di vita;
    • chest rehabilitation, comprendente interventi di mobilizzazione precoce, training della muscolatura inspiratoria, iperinflazione manuale, percussioni/vibrazioni della parete toracica, rimozione delle secrezioni, tosse guidata, si accompagna a riduzione degli insuccessi nell’estubazione dei pazienti ventilati meccanicamente.

    Nell’ambito della ventilazione non invasiva (NIV), i fisioterapisti oltre a potersi occupare dei pazienti che la utilizzano, possono integrare altre tecniche per gestire insufficienza respiratoria acuta e cronica. Per il corretto utilizzo della NIV, tuttavia, sono necessari percorsi di istruzione sia per i fisioterapisti che per i pazienti, con il vantaggio di ridurre il tempo impiegato da altri professionisti della salute nell’educazione dei pazienti e ottimizzando la gestione delle attività svolte in reparto.

    Nel caso del trattamento riabilitativo in acuto dei pazienti affetti da Covid-19, infine, è da tenere in grande considerazione il rischio di infezione per i fisioterapisti che si occupano di riabilitazione respiratoria, dal momento che le tecniche riabilitative utilizzate normalmente sono responsabili della generazione di aerosol, per cui si rende necessario il corretto utilizzo dei dispositivi di protezione individuale.

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