An experimental pre-post study on the efficacy of respiratory physiotherapy in severe critically iii covid-19 patients

Denise Battaglini, Salvatore Caiffa, Giovanni Gasti, Elena Ciaravolo, Chiara Robba, Jacob Herrmann, Sarah E. Gerard, Matteo Bassetti, Paolo Pelosi, Lorenzo Ball

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Respiratory physiotherapy (RPT) is considered essential in patients’ management during intensive care unit (ICU) stay. The role of RPT in critically ill COVID-19 patients is poorly described. We aimed to investigate the effects of RPT on oxygenation and lung aeration in critically ill COVID-19 patients admitted to the ICU. Methods: Observational pre-post study. Patients with severe COVID-19 admitted to the ICU, who received a protocolized CPT session and for which a pre-and post-RPT lung ultrasound (LUS) was performed, were included. A subgroup of patients had an available quantitative computed tomography (CT) scan performed within 4 days from RPT. The primary aim was to evaluate whether RPT improved oxygenation; secondary aims included correlations between LUS, CT and response to RPT. Results: Twenty patients were included. The median (1st–3rd quartile) PaO2/FiO2 was 181 (105–456), 244 (137–497) and 246 (137–482) at baseline (T0), after RPT (T1), and after 6 h (T2), respectively. PaO2/FiO2 improved throughout the study (p = 0.042); particularly, PaO2/FiO2 improved at T1 in respect to T0 (p = 0.011), remaining higher at T2 (p = 0.007) compared to T0. Correlations between LUS, volume of gas (rho = 0.58, 95%CI 0.05–0.85, p = 0.033) and hyper-aerated mass at CT scan (rho = 0.54, 95% CI 0.00–0.84, p = 0.045) were detected. No significant changes in LUS score were observed before and after RPT. Conclusions: RPT improved oxygenation and the improvement persisted after 6 h. Oxygenation improvement was not reflected by aeration changes assessed with LUS. Further studies are warranted to assess the efficacy of RPT in COVID-19 ICU patients.

Original languageEnglish
Article number2139
JournalJournal of Clinical Medicine
Volume10
Issue number10
DOIs
Publication statusPublished - May 2 2021

Keywords

  • Chest physiotherapy
  • COVID-19
  • Intensive care unit
  • Lung ultrasound
  • Rehabilitation
  • Respiratory physiotherapy
  • SARS-CoV-2

ASJC Scopus subject areas

  • Medicine(all)

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