Fisioterapia em pacientes adultos em estado crítico internados com COVID-19: revisão integrativa
Natália de Souza Ribeiro, Daianny Seoni de Oliveira, Liria Yuri Yamauchi
Resumo
Introdução: A pandemia de COVID-19 afetou a vida de milhares de pessoas, principalmente pela sua alta taxa de mortalidade e sequelas. Dados da literatura evidenciam que entre os pacientes internados em unidade de terapia intensiva, a maioria foi devido à insuficiência respiratória hipoxêmica, logo, a atuação do fisioterapeuta intensivista vem mostrando-se fundamental na reabilitação desses pacientes. Objetivo: Avaliar e descrever as principais condutas e efeitos da fisioterapia em pacientes adultos infectados com COVID-19 sob cuidados intensivos. Métodos: Revisão integrativa da literatura incluindo estudos que relataram intervenções fisioterapêuticas em pacientes adultos sob cuidado intensivo, disponíveis eletronicamente de janeiro de 2019 a junho de 2021. Após a formulação da pergunta norteadora, cruzaram-se os descritores: “COVID-19”, “Unidade de Terapia Intensiva” e “Fisioterapia”. Utilizou-se as bases de dados Biblioteca Virtual em Saúde (BVS), PUBMED, EMBASE e Physiotherapy Evidence Database (PEDro). Resultados: Foram resgatados 698 artigos e após os processos de seleção e análise, 38 foram incluídos nesta revisão. Os artigos analisados possuem características observacionais, narrativas, revisionais e experimentais. As condutas fisioterapêuticas mais citadas foram relacionadas à ventilação mecânica invasiva (n=9); técnicas de remoção de secreção (n=13) e de expansão pulmonar (n=9); exercícios respiratórios (n=14); exercícios passivos e ativos (n=23), exercícios de transferência e mudanças de posição (n=17). Conclusão: Os resultados reforçam a importância da atuação do fisioterapeuta, principalmente em pacientes submetidos à internação e intubação pela COVID-19. Novos estudos serão necessários para avaliar o impacto da fisioterapia, tanto intra-hospitalar quanto após a alta hospitalar, na recuperação da qualidade de vida e da funcionalidade dessa população.
Palavras-chave
Referências
1. Dhama K, Khan S, Tiwari R, Sircar S, Bhat S, Malik YS, et al. Coronavirus disease 2019-COVID-19. Clin Microbiol Rev. 2020 Jun 24;33(4):e00028-20. http://dx.doi.org/10.1128/ CMR.00028-20.
2. Ranzani OT, Bastos LSL, Gelli JGM, Marchesi JF, Baião F, Hamacher S, et al. Characterisation of the first 250.000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data. Lancet Respir Med. 2021;9(4):407-18. http://dx.doi.org/10.1016/S2213-2600(20)30560-9.
3. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA. 2020;324(8):782-93. http://dx.doi.org/10.1001/ jama.2020.12839.
4. França EET, Ferrari F, Fernandes P, Cavalcanti R, Duarte A, Martinez BP, et al. Fisioterapia em pacientes críticos adultos: recomendações do Departamento de Fisioterapia da Associação de Medicina Intensiva Brasileira. Rev Bras Ter Intensiva. 2012;24(1):6-22. http://dx.doi.org/10.1590/ S0103-507X2012000100003.
5. Alves NA. A importância da atuação do fisioterapeuta no ambiente hospitalar. Ensaios e Ciência: Ciências Biológicas, Agrárias e de Saúde. [Internet]; 2012 [citado em 2021 Out 14];16(6):173-84. Disponível em: http://www.redalyc.org/ articulo.oa?id=26032923015
6. Furtado MVC, Costa ACF, Silva JC, Amaral CA, Nascimento PGD, Marques LM et al. Atuação da fisioterapia na UTI. BJHR 2020;3(6):16335-49.
7. Ercole FF, Melo LS, Alcoforado CLGC. Integrative review versus systematic review. Reme: Revista Mineira de Enfermagem. 2014;18(1). http://dx.doi.org/10.5935/1415-2762.20140001
8. de Souza MT, da Silva MD, de Carvalho R. Revisão integrativa: o que é e como fazer. Einstein. [Internet]; 2010 [citado em 2021 Out 14];8(1 Pt 1):102-6. Disponível em: https://www. scielo.br/pdf/eins/v8n1/pt_1679-4508-eins-8-1-0102.pdf
9. Galvão TF, Pansani TSA, Harrard D. Principais itens para relatar Revisões sistemáticas e Meta-análises: a recomendação PRISMA. Epidemiol. Serv. Saúde 2015;24(2):335-42. https:// doi.org/10.5123/S1679-49742015000200017.
10. Galvão TF, Pereira MG. Revisões sistemáticas da literatura: passos para sua elaboração. Epidemiol Serv Saude. 2014;23(1):183-4. http://dx.doi.org/10.5123/S1679- 49742014000100018.
11. Botelho LLR, Cunha CCA, Macedo M. O método da revisão integrativa nos estudos organizacionais. GeS. 2011;5(11):121. http://dx.doi.org/10.21171/ges.v5i11.1220.
12. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. http://dx.doi.org/10.1186/s13643-016- 0384-4.
13. Lazzeri M, Lanza A, Bellini R, Bellofiore A, Cecchetto S, Colombo A, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. 2020;90(1). http://dx.doi. org/10.4081/monaldi.2020.1285.
14. Pereira-Rodríguez JE, Waiss-Skvirsky SS, Velásquez-Badillo X, Lopez-Florez O, Quintero-Gómez JC. Fisioterapia y su reto frente al covid-19. Preprint. 2020;1-14. https://doi. org/10.1590/SciELOPreprints.157.
15. Kalirathinam D, Guruchandran R, Subramani P. Comprehensive physiotherapy management in covid-19 – a narrative review. Sci Med (Phila). 2020;30(1):38030. http:// dx.doi.org/10.15448/1980-6108.2020.1.38030.
16. Lee AJY, Chung CLH, Young BE, Ling LM, Ho BCH, Puah SH, et al. Clinical course and physiotherapy intervention in 9 patients with COVID-19. Physiotherapy. 2020;109:1-3. http://dx.doi.org/10.1016/j.physio.2020.06.002.
17. Kiekens C, Boldrini P, Andreoli A, Avesani R, Gamna F, Grandi M, et al. Rehabilitation and respiratory management in the acute and early post-acute phase. “Instant paper from the field” on rehabilitation answers to the COVID-19 emergency. Eur J Phys Rehabil Med. 2020;56(3):323-6. http://dx.doi. org/10.23736/S1973-9087.20.06305-4.
18. Felten-Barentsz KM, van Oorsouw R, Klooster E, Koenders N, Driehuis F, Hulzebos EHJ, et al. Recommendations for Hospital-based physical therapists managing patients with COVID-19. Phys Ther. 2020;100(9):1444-57. http://dx.doi. org/10.1093/ptj/pzaa114.
19. Battaglini D, Robba C, Caiffa S, Ball L, Brunetti I, Loconte M, et al. Chest physiotherapy: an important adjuvant in critically ill mechanically ventilated patients with COVID-19. Respir Physiol Neurobiol. 2020;282:103529. http://dx.doi. org/10.1016/j.resp.2020.103529.
20. Candan SA, Elibol N, Abdullahi A. Consideration of prevention and management of long-term consequences of post-acute respiratory distress syndrome in patients with COVID-19. Physiother Theory Pract. 2020;36(6):663-8. http://dx.doi.or g/10.1080/09593985.2020.1766181.
21. Pincherle A, Jöhr J, Pancini L, Leocani L, Dalla Vecchia L, Ryvlin P, et al. Intensive Care Admission and Early Neuro- Rehabilitation. Lessons for COVID-19? Front Neurol. 2020;11:880. http://dx.doi.org/10.3389/fneur.2020.00880.
22. Beom J, Jung J, Hwang I-C, Cho Y-J, Kim ES, Kim HB et al. Early rehabilitation in a critically ill inpatient with COVID-19. Eur J Phys Rehabil Med. 2020;56(6):858-61.
23. Nasuelli NA, Pettinaroli R, Godi L, Savoini C, de Marchi F, Mazzini L, et al. Critical illness neuro-myopathy (CINM) and focal amyotrophy in intensive care unit (ICU) patients with SARS-CoV-2: a case series. Neurol Sci. 2021;42(3):1119-21. http://dx.doi.org/10.1007/s10072-020-04820-9.
24. Lalwani L, Mishra G, Gaidhane A, Quazi N, Taksande A. Chest physiotherapy in patients admitted to the intensive care unit with COVID-19: a review. Open Public Health J. 2021;14(1):145-8. http://dx.doi.org/10.2174/18749445021 14010145.
25. Sañudo B, Seixas A, Gloeckl R, Rittweger J, Rawer R, Taiar R, et al. Potential application of whole body vibration exercise for improving the clinical conditions of COVID-19 Infected Individuals: a narrative review from the World Association of Vibration Exercise Experts (WAVex) Panel. Int J Environ Res Public Health. 2020;17(10):3650. http://dx.doi. org/10.3390/ijerph17103650.
26. Thakre P, Naqvi WM, Deshmukh T, Ingole N, Deshmukh S. Crucial role of physiotherapy in treating COVID-19 patients. IJRPS. 2020;11(Spec l ):967-71.
27. Sagarra-Romero L, Viñas-Barros A. COVID-19: short and long-term effects of hospitalization on muscular weakness in the elderly. Int J Environ Res Public Health. 2020;17(23):8715. http://dx.doi.org/10.3390/ijerph17238715.
28. McWilliams D, Weblin J, Hodson J, Veenith T, Whitehouse T, Snelson C. Rehabilitation levels in patients with COVID-19 admitted to intensive care requiring invasive ventilation: an observational study. AnnalsATS. 2021;18(1):122-9. http:// dx.doi.org/10.1513/AnnalsATS.202005-560OC.
29. Sakai T, Hoshino C, Hirao M, Yamaguchi R, Nakahara R, Okawa A. Rehabilitation for patients with COVID-19: a Japanese Single-center experience. Prog. Rehabil. Med. 2021;6(0):1-5. http://dx.doi.org/10.2490/prm.20210013.
30. Cheng Y-Y, Chen C-M, Huang W-C, Chiang S-L, Hsieh P-C, Lin K-L, et al. Rehabilitation programs for patients with COronaVIrus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation. J Formos Med Assoc. 2021;120(1 Pt 1):83-92. http://dx.doi. org/10.1016/j.jfma.2020.08.015.
31. Eggmann S, Kindler A, Perren A, Ott N, Johannes F, Vollenweider R, et al. Early physical therapist interventions for patients with COVID-19 in the Acute Care Hospital: a case report series. Phys Ther. 2021;101(1):1-9. http://dx.doi.org/10.1093/ptj/pzaa194.
32. Li L, Yu P, Yang M, Xie W, Huang L, He C, et al. Physical therapist management of COVID-19 in the Intensive Care Unit: The West China Hospital Experience. Phys Ther. 2021;101(1):pzaa198.
33. Organização Panamericana de Saúde. Guia para os cuidados críticos de pacientes adultos graves com coronavírus (covid-19) nas américas versão curta - V1. USA: OPAS; 2020. p. 1-17.
34. Adhikari SP, Dev R, Sandborgh M. Alternatives to routinely used physiotherapy interventions for achieving maximum patients’ benefits and minimising therapists’ exposure in treatment of COVID-19 – a commentary. Eur J Physiother. 2020;22(6):373-8. http://dx.doi.org/10.1080/21679169.202 0.1800816.
35. Bernal-Utrera C, Anarte-Lazo E, Gonzalez-Gerez JJ, De-La- Barrera-Aranda E, Saavedra-Hernandez M, Rodriguez- Blanco C. Could Physical Therapy Interventions be Adopted in the Management of Critically Ill Patients with COVID-19? A scoping review. Int J Environ Res Public Health. 2021;18(4):1627. http://dx.doi.org/10.3390/ijerph18041627.
36. Battaglini D, Caiffa S, Gasti G, Ciaravolo E, Robba C, Herrmann J, et al. An experimental pre-post study on the efficacy of respiratory physiotherapy in severe Critically III COVID-19 patients. An experimental pre-post study on the efficacy of respiratory physiotherapy in severe Critically III COVID-19 Patients. J Clin Med. 2021;10(2139):1-12.
37. Pegado R, Silva-Filho E, Lima INDF, Gualdi L. Coronavirus disease 2019 (COVID-19) in Brasil: information to physical therapists. Rev Assoc Med Bras. 2020;66(4):498-501.
38. Ng JA, Miccile LA, Iracheta C, Berndt C, Detwiller M, Yuse C, et al. Prone positioning of patients with acute respiratory distress syndrome related to COVID-19: a rehabilitation-based prone team. Phys Ther. 2020;100(10):1737-45. http:// dx.doi.org/10.1093/ptj/pzaa124.
39. Rauseo M, Mirabella L, Caporusso RR, Cantatore LP, Perrini MP, Vetuschi P, et al. SARS-CoV-2 pneumonia succesfully treated with cpap and cycles of tripod position: a case report. BMC Anesthesiol. 2021;21(9):1-4. http://dx.doi.org/10.1186/ s12871-020-01221-5.
40. Ballesteros Reviriego G, Planas Pascual B, Rojo Ruiz A, Sánchez Romero EA, Corbelini C, Villafañe JH. Spanish experience of pulmonary rehabilitation efficacy for patients affected by the novel SARS-CoV-2 (COVID-19). Top Geriatr Rehabil. 2020;36(4):212-4. http://dx.doi.org/10.1097/ TGR.0000000000000283.
41. Polastri M, Daniele F, Tagariello F. Assisted mobilisation in critical patients with COVID-19. Pulmonology. 2021. In press. http://dx.doi.org/10.1016/j.pulmoe.2021.01.004.
42. Mark A, Crumley JP, Rudolph KL, Doerschug K, Krupp A. Maintaining mobility in a patient who is pregnant and has COVID-19 requiring extracorporeal membrane oxygenation: a case report. Phys Ther. 2021 Jan 4;101(1):pzaa189.
43. Goodwin VA, Allan L, Bethel A, Cowley A, Cross JL, Day J, et al. Rehabilitation to enable recovery from COVID-19: a rapid systematic review. Physiotherapy. 2021;111:4-22. http:// dx.doi.org/10.1016/j.physio.2021.01.007.
44. Burgess LC, Venugopalan L, Badger J, Street T, Alon G, Jarvis JC, et al. Effect of neuromuscular electrical stimulation on the recovery of people with COVID-19 admitted to the intensive care unit: a narrative review. J Rehabil Med. 2021;53(3):00164. http://dx.doi.org/10.2340/16501977- 2805.
45. Rich J, Coman M, Sharkey A, Church D, Pawson J, Thomas A. A single center observational study of the incidence, frequency and timing of critical care physiotherapy intervention during the COVID-19 pandemic. J Intensive Care Soc. 2021;1751143721991060. http://dx.doi. org/10.1177/1751143721991060.
46. Siddiq MAB, Rathore FA, Clegg D, Rasker JJ. Pulmonary Rehabilitation in COVID-19 patients: a scoping review of current practice and its application during the pandemic. Turk J Phys Med Rehab. 2020;66(4):480-94. http://dx.doi. org/10.5606/tftrd.2020.6889.
47. Karamouzos V, Fligou F, Gogos C, Velissaris D. High flow nasal cannula oxygen therapy in adults with COVID-19 respiratory failure. A case report. Monaldi Arch Chest Dis. 2020;90(2). http://dx.doi.org/10.4081/monaldi.2020.1323.
48. Vianello A, Arcaro G, Molena B, Turato C, Sukthi A, Guarnieri G, et al. Highflow nasal cannula oxygen therapy to treat patients with hypoxemic acute respiratory failure consequent to SARS-CoV-2 infection. Thorax. 2020;75(11):998-1000. http://dx.doi.org/10.1136/thoraxjnl-2020-214993.
49. Abodonya AM, Abdelbasset WK, Awad EA, Elalfy IE, Salem HA, Elsayed SH. Inspiratory muscle training for recovered COVID-19 patients after weaning from mechanical ventilation: a pilot control clinical study. Medicine 2021;100(13):e25339.
50. Shakerian N, Mofateh R, Rezaei N, Saghazadeh A, Rezaei N. Potential prophylactic and therapeutic effects of respiratory physiotherapy for COVID-19. Acta Biomed. 2021;92:e2021020.
Submetido em:
14/10/2021
Aceito em:
13/05/2022
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email