scholarly journals Case Report: A Rehabilitation Practice Report During ICU Management for a Patient With Multiple Disabilities Due to COVID-19 Pneumonia and COPD

2021 ◽  
Vol 8 ◽  
Author(s):  
Tokio Kinoshita ◽  
Ken Kouda ◽  
Yasunori Umemoto ◽  
Yoshinori Yasuoka ◽  
Yuta Minoshima ◽  
...  
Keyword(s):  
Daily Living ◽  
Deep Sedation ◽  
Early Mobilization ◽  
Multiple Disabilities ◽  
Exercise Intolerance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Respiratory Management ◽  
Ventilator Management ◽  
Pulmonary Protection

Patients with severe coronavirus disease (COVID-19) and admitted to the intensive care unit (ICU) are at high risk of developing ICU-acquired weakness and disuse syndrome. Although their medical management may include prolonged deep sedation for pulmonary protection and ventilator management, we aim for early mobilization of these patients with COVID-19. We present the case of a 71-year-old man with chronic obstructive pulmonary disease (COPD) and COVID-19 pneumonia. Passive range of motion training and sitting on the edge of the bed were started in the ICU while the patient was under deep sedation. His activities of daily living eventually improved to where he could independently walk to the toilet without respiratory distress. Patients with severe COVID-19 who require mechanical ventilation are at risk of muscle weakness and exercise intolerance. These patients require rehabilitation therapy, beginning in the acute phase of illness, to recover their physical function. Although validation with a larger cohort is necessary, our results suggest that patients with COPD and COVID-19 pneumonia should undergo rehabilitation concurrently with status-driven changes in respiratory management.

scholarly journals Chronic obstructive pulmonary disease Assessment Test na avaliação de pacientes com doença pulmonar obstrutiva crônica em reabilitação pulmonar: há relação com nível de dispneia nas atividades de vida diária e com índice preditor de mortalidade? Estudo transversal

2013 ◽  
Vol 20 (4) ◽  
pp. 379-386
Author(s):  
Júlia Gianjoppe-Santos ◽  
Samantha Maria Nyssen ◽  
Bruna Varanda Pessoa ◽  
Renata Pedrolongo Basso-Vanelli ◽  
Mauricio Jamami ◽  
...  
Keyword(s):  
Daily Living ◽  
Research Council ◽  
Medical Research Council ◽  
Airflow Obstruction ◽  
Disease Assessment ◽  
Chronic Obstructive ◽  
Activity Of Daily Living ◽  
Obstructive Pulmonary Disease ◽  
Copd Assessment Test ◽  
Indice Bode

O objetivo do estudo foi investigar se há relação entre o impacto da Doença Pulmonar Obstrutiva Crônica (DPOC) no estado de saúde com o nível de dispneia nas atividades de vida diária (AVD) e o índice preditor de mortalidade em pacientes em reabilitação pulmonar (RP). Trata-se de um estudo transversal, em que foram avaliados 32 pacientes com DPOC moderada a muito grave (23 homens; 66,6±12,0 anos; VEF1: 40,6±15,6% previsto) por meio do COPD Assessment Test (CAT), Índice de Massa Corpórea (IMC), Teste de Caminhada de Seis Minutos (TC6), London Chest Activity of Daily Living Scale (LCADL), modified Medical Research Council (mMRC) e Índice BODE (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity). Observaram-se correlações positivas moderadas do CAT com o questionário mMRC (r=0,35; p=0,048), a pontuação total da LCADL (r=0,60; p<0,001) e com a porcentagem da pontuação total da LCADL (r=0,57; p=0,001). Apenas a pontuação total da LCADL é capaz de predizer independentemente a pontuação do questionário CAT (p<0,05; r²=0,61). Não foram constatadas correlações significativas entre o CAT e o Índice BODE, IMC, TC6 e VEF1. Dessa forma, quanto maior o nível de dispneia nas AVD, maior o impacto da DPOC no estado de saúde do paciente, entretanto, o mesmo não ocorre em relação ao prognóstico de mortalidade nos pacientes com DPOC em RP.

scholarly journals Mechanisms of exercise intolerance in Global Initiative for Chronic Obstructive Lung Disease grade 1 COPD

2014 ◽  
Vol 44 (5) ◽  
pp. 1177-1187 ◽  
Author(s):  
Jordan A. Guenette ◽  
Roberto C. Chin ◽  
Sicheng Cheng ◽  
Paolo B. Dominelli ◽  
Natya Raghavan ◽  
...  
Keyword(s):  
Work Of Breathing ◽  
Pressure Ratio ◽  
Chronic Obstructive Lung Disease ◽  
Exercise Intolerance ◽  
Chronic Obstructive ◽  
Respiratory Drive ◽  
Obstructive Pulmonary Disease ◽  
Transdiaphragmatic Pressure ◽  
Generating Capacity ◽  
Neuromuscular Abnormalities

The purpose of this study was to determine if a dissociation existed between respiratory drive, as estimated by diaphragmatic electromyography (EMGdi), and its pressure-generating capacity during exercise in mild chronic obstructive pulmonary disease (COPD) and whether this, if present, had negative sensory consequences.Subjects meeting spirometric criteria for mild COPD (n=16) and age and sex-matched controls (n=16) underwent detailed pulmonary function testing and a symptom limited cycle test while detailed ventilatory, sensory and respiratory mechanical responses were measured.Compared with controls, subjects with mild COPD had greater ventilatory requirements throughout submaximal exercise. At the highest equivalent work rate of 60 W, they had a significantly higher: total work of breathing (32±17 versus 16±7 J·min−1; p<0.01); EMGdi (37.3±17.3 versus 17.9±11.7% of maximum; p<0.001); and EMGdi to transdiaphragmatic pressure ratio (0.87±0.38 versus 0.52±0.27; p<0.01). Dyspnoea–ventilation slopes were significantly higher in mild COPD than controls (0.17±0.12 versus 0.10±0.05; p<0.05). However, absolute dyspnoea ratings reached significant levels only at high levels of ventilation.Increased respiratory effort and work of breathing, and a wider dissociation between diaphragmatic activation and pressure-generating capacity were found at standardised work rates in subjects with mild COPD compared with controls. Despite these mechanical and neuromuscular abnormalities, significant dyspnoea was only experienced at higher work rates.

Neuromuscular Electrical Stimulation: A New Therapeutic and Rehabilitation Strategy in the ICU

2014 ◽  
Author(s):  
Vasiliki Gerovasili ◽  
Serafim N Nanas
Keyword(s):  
Electrical Stimulation ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Neuromuscular Electrical Stimulation ◽  
Early Mobilization ◽  
Alternative Form ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
And Function

Many critically ill patients undergo a period of immobilization with detrimental effects on skeletal muscle, effects which seem most pronounced in the first days of critical illness. Diagnosis of intensive care unit muscle weakness (ICUAW) is often made after discontinuation of sedation when significant nerve and/or muscle damage may already have occurred. Recently, there has been interest in early mobilization during the acute phase of critical illness, with the goal of preventing ICUAW. Neuromuscular electrical stimulation (NEMS) is an alternative form of exercise that has been successfully used in patients with advanced chronic obstructive pulmonary disease (COPD) and chronic heart failure. NEMS is a rehabilitation tool that can be used in critically ill, sedated patients, does not require patient cooperation, and is therefore a promising intervention to prevent muscle dysfunction in the critically ill. When applied early during the course of critical illness, NEMS can preserve muscle morphology and function. Available evidence suggests that NEMS may have a preventive role in the development of ICUAW and could even contribute to a shorter duration of weaning from mechanical ventilation. Studies are needed to evaluate the long-term effect of NEMS and to explore NEMS settings and delivery characteristics most appropriate for different subgroups of critically ill patients.

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