ASSOBRAFIR Ciência
https://assobrafirciencia.org/article/doi/10.47066/2177-9333.AC20.covid19.018
ASSOBRAFIR Ciência
Artigo Especial

Avaliação e intervenção para a reabilitação cardiopulmonar de pacientes recuperados da COVID-19*

Evaluation and intervention for cardiopulmonary rehabilitation of COVID-19 recovered patients*

Lucas de Assis Pereira Cacau, Rafael Mesquita, Karina Couto Furlanetto, Daniel Lago Silva Borges, Luiz Alberto Forgiarini Junior, Vinicius Maldaner, Yves de Souza, Gerson Cipriano Júnior, Celso Carvalho, Ingrid Correia Nogueira, Laura Tomazi, Marlus Karsten

Downloads: 38
Views: 1090

Resumo

Com a pandemia de COVID-19, é necessário o rápido entendimento das prováveis e graves sequelas que os pacientes sobreviventes podem desenvolver, assim como torna-se urgente traçar planos de ação para enfrentar tal situação desde o processo de alta hospitalar até a inserção em serviços de reabilitação cardiopulmonar. De acordo com recomendações internacionais, uma avaliação individualizada deve ser realizada e documentada no momento da alta, a qual deve contemplar as necessidades imediatas (controle dos sintomas como dispneia, fadiga e dor), assim como as necessidades a curto e médio prazo (melhora da função física e emocional; retorno ao trabalho; dentre outros). É aconselhável que nas primeiras semanas após a alta, o paciente seja atendido através de comunicação digital, a qual deve incluir imagem e áudio por questões de segurança. Componentes mandatórios dos programas de reabilitação cardiopulmonar incluem exercícios de força e resistência, além do trabalho da musculatura inspiratória. A abordagem educacional, é item importante no processo de tratamento. A reabilitação de doentes críticos acometidos por COVID-19 após alta hospitalar é de fundamental importância, especialmente naqueles que evoluíram com o quadro grave da doença, e que necessitaram de internação em UTI.

Palavras-chave

Fisioterapia; Reabilitação cardiopulmonar; COVID-19.

Abstract

With the pandemic of COVID-19, it is necessary to quickly understand the probable and serious sequelae that surviving patients may develop, as well as it is urgent to draw up action plans to face this situation, which begins from the discharge process until insertion in cardiopulmonary rehabilitation services. According to international recommendations, an individualized assessment must be performed and documented at the time of discharge, which must include immediate needs (control of symptoms such as dyspnoea, fatigue and pain), as well as short and medium term needs (improvement of physical and emotional function; return to work; among others). It is recommended that in the first weeks after discharge, supervision occurs through digital communication, which must include image and audio for security reasons. Mandatory components of cardiopulmonary rehabilitation programs include strength and endurance exercises, in addition to the inspiratory muscles work. The educational approach is also an important item in the treatment process. The rehabilitation of critically ill patients affected by COVID-19 after hospital discharge is of interest, especially in those who developed the severe condition of the disease or required ICU admission.

Keywords

Physiotherapy; Cardiopulmonary rehabilitation; COVID-19.

Referências

1. Choon-Huat Koh G, Hoenig H. How Should the Rehabilitation Community Prepare for 2019- nCoV? Arch Phys Med Rehabil. 2020 Jun;101(6):1068-1071. doi: 10.1016/j.apmr.2020.03.003. Epub 2020 Mar 16.

2. Spruit MA, Holland AE, Singh SJ, Troosters T. Report of an ad-hoc international task force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in COVID-19 survivors (version April 3, 2020). [Lausanne: European Respiratory Society; 2020].182 Available from: https://ers.box.com/s/npzkvigtl4w3pb0vbsth4y0fxe7ae9z9

3. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020 Apr;66(2):73-82. doi: 10.1016/j.jphys.2020.03.011. Epub 2020 Mar 30.

4. Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020 Jun;80(6):639-645. doi: 10.1016/j.jinf.2020.03.019. Epub 2020 Mar 30.

5. Du R-H, Liang L-R, Yang C-Q, Wang W, Cao T-Z, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020 May 7;55(5):2000524. doi: 10.1183/13993003.00524-2020. Print 2020 May.

6. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA. 2020 Feb 24. doi: 10.1001/jama.2020.2648. Online ahead of print.

7. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020 Apr 6;323(16):1574-1581. doi: 10.1001/jama.2020.5394. Online ahead of print.

8. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020 Apr 22;323(20):2052-2059. doi: 10.1001/jama.2020.6775. Online ahead of print.

9. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol. 2020 Aug;30(8):4381-4389. doi: 10.1007/s00330-020-06801-0. Epub 2020 Mar 19.

10. da Costa CC, de Azeredo Lermen C, Colombo C, Canterle DB, Machado MLL, Kessler A, et al. Effect of a Pulmonary Rehabilitation Program on the levels of anxiety and depression and on the quality of life of patients with chronic obstructive pulmonary disease. Rev Port Pneumol. 2014 NovDec;20(6):299-304. doi: 10.1016/j.rppneu.2014.03.007. Epub 2014 May 27.

11. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020 Feb 7;323(11):1061-1069. doi: 10.1001/jama.2020.1585. Online ahead of print.

12. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System. JAMA Cardiol. 2020 Mar 27. doi: 10.1001/jamacardio.2020.1286. Online ahead of print.

13. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. 2020 Mar 19;323(16):1612-4. doi: 10.1001/jama.2020.4326. Online ahead of print.

14. Du R-H, Liu L-M, Yin W, Wang W, Guan L-L, Yuan M-L, et al. Hospitalization and Critical Care of 109 Decedents with COVID-19 Pneumonia in Wuhan, China. Ann Am Thorac Soc. 2020 Jul;17(7):839-846. doi: 10.1513/AnnalsATS.202003-225OC.

15. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Mar 27;5(7):1-8. doi: 10.1001/jamacardio.2020.1017. Online ahead of print.

16. Liu K, Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract. 2020 May;39:101166. doi: 10.1016/j.ctcp.2020.101166. Epub 2020 Apr 1.

17. Latronico N, Gosselink R. A guided approach to diagnose severe muscle weakness in the intensive care unit. Rev Bras Ter Intensiva. Jul-Sep 2015;27(3):199-201. doi: 10.5935/0103-507X.20150036. Epub 2015 Sep 15.

18. Bissett B, Leditschke IA, Green M, Marzano V, Collins S, van Haren F. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care. 2019 May;32(3):249-55. doi: 10.1016/j.aucc.2018.06.001. Epub 2018 Jul 11.

19. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11.

20. Matte DL, Cacau L de AP, Reis LF da F, Assis MC. Recomendações sobre o uso de equipamentos de proteção individual (EPIs) no ambiente hospitalar e prevenção de transmissão cruzada na COVID-19 [Internet]. São Paulo: ASSOBRAFIR; 2020. Available from: https://assobrafir.com.br/wp-content/uploads/2020/04/ASSOBRAFIR-COVID-19-EPIs_2020.04.15.pdf.

21. Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020 Jun 18;55(6):2001217. doi: 10.1183/13993003.01217-2020. Print 2020 Jun.

22. Klok FA, Boon GJAM, Barco S, Endres M, Geelhoed JJM, Knauss S, et al. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19. Eur Respir J. 2020 Jul 2;56(1):2001494. doi: 10.1183/13993003.01494-2020. Print 2020 Jul.

23. Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/ American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014 Dec;44(6):1428-46. doi: 10.1183/09031936.00150314. Epub 2014 Oct 30.

24. Pitta F, Troosters T, Probst VS, Langer D, Decramer M, Gosselink R. Are patients with COPD more active after pulmonary rehabilitation? Chest. 2008 Aug;134(2):273-280. doi: 10.1378/chest.07-2655. Epub 2008 Apr 10.

25. Demeyer H, Burtin C, Hornikx M, Camillo CA, Van Remoortel H, Langer D, et al. The Minimal Important Difference in Physical Activity in Patients with COPD. PLoS One. 2016 Apr 28;11(4):e0154587. doi: 10.1371/journal.pone.0154587. eCollection 2016.

26. Watz H, Pitta F, Rochester CL, Garcia-Aymerich J, ZuWallack R, Troosters T, et al. An official European Respiratory Society statement on physical activity in COPD. Eur Respir J. 2014 Dec;44(6):1521-37. doi: 10.1183/09031936.00046814. Epub 2014 Oct 30.

27. Karloh M, Araujo CLP, Gulart AA, Reis CM, Steidle LJM, Mayer AF. The Glittre-ADL test reflects functional performance measured by physical activities of daily living in patients with chronic obstructive pulmonary disease. Braz J Phys Ther. 2016 Apr 8;20(3):223-30. doi: 10.1590/bjpt-rbf.2014.0155.

28. Sant’Anna T, Donária L, Furlanetto KC, Morakami F, Rodrigues A, Grosskreutz T, et al. Development, Validity and Reliability of the Londrina Activities of Daily Living Protocol for Subjects With COPD. Respir Care. 2017 Mar;62(3):288-297. doi: 10.4187/respcare.05058. Epub 2017 Jan 31.

29. Marra A, Pandharipande PP, Girard TD, Patel MB, Hughes CG, Jackson JC, et al. Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness. Crit Care Med. 2018 Sep;46(9):1393-1401. doi: 10.1097/CCM.0000000000003218.

30. Kitsiou S, Paré G, Jaana M. Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews. J Med Internet Res. 2015 Mar 12;17(3):e63. doi: 10.2196/jmir.4174.

31. Chen S-Y, Chang Y-H, Hsu H-C, Lee Y-J, Hung Y-J, Hsieh C-H. One-Year Efficacy and Safety of the Telehealth System in Poorly Controlled Type 2 Diabetic Patients Receiving Insulin Therapy. Telemed J E Health. 2011 Nov;17(9):683-7. doi: 10.1089/tmj.2011.0020. Epub 2011 Sep 1.

32. Vieira DS, Maltais F, Bourbeau J. Home-based pulmonary rehabilitation in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med. 2010 Mar;16(2):134-43. doi: 10.1097/MCP.0b013e32833642f2.

33. de Souza Y, da Silva KM, Condesso D, Figueira B, Noronha Filho AJ, Rufino R, et al. Use of a HomeBased Manual as Part of a Pulmonary Rehabilitation Program. Respir Care. 2018 Dec;63(12):1485- 1491. doi: 10.4187/respcare.05656. Epub 2018 Aug 7.

34. Leal L, Gonçalves D, Azevedo J, Mazeika PV, Mendonça W, Reis F, et al. Use of a simple telecoaching pulmonary rehabilitation protocol for COPD patients. Eur Respir J. 2019; 54(Suppl. 63). doi: 10.1183/13993003.congress-2019.PA1260

35. Demeyer H, Louvaris Z, Frei A, Rabinovich RA, de Jong C, Gimeno-Santos E, et al. Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial. Thorax. 2017 May;72(5):415-423. doi: 10.1136/thoraxjnl-2016-209026. Epub 2017 Jan 30.

36. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct 15;188(8):e13-64. doi: 10.1164/rccm.201309-1634ST.

5f6dfa570e8825e42997b915 assobrafir Articles
Links & Downloads

ASSOBRAFIR Ciência

Share this page
Page Sections