Clinical Effect of Pulmonary Rehabilitation on Patients with Severe or Critically Severe COVID-19 Pneumonia

Abstract

The spreading of coronavirus disease 2019 (COVID-19) is an emerging global threat. Optimal treatment for severe COVID-19 pneumonia is extremely urgent. We conducted this study to evaluate the safety, feasibility and effect of pulmonary rehabilitation (PR) intervention in the treatment of patients with severe or critically severe COVID-19 pneumonia. Methods: In this retrospective study, 43 patients with severe or critically severe COVID-19 pneumonia were included and divided into conserved intervention group (C-I group) and advanced intervention group (A-I group) according to the initiation time of PR intervention. The PR intervention includes education, respiratory rehabilitation, physical training, psychological counseling and nutrition management. Oxygenation Index (OI), blood d-dimer level, lymphocyte count and other laboratory findings were recorded. Results: The median age was 54 years (range 21 to 75 years); 11 (25.6%) were 65 or older. 24 (55.8%) were male. All patients safely finished a certain course of pulmonary rehabilitation. The OI could increase to moderate level (>300mmHg) during ICU treatment, and the A-I group showed a faster trend. The time of OI increased to moderate level was significantly shorter than that in C-I group (p=0.02). Lymphocytopenia occurred in 35 patients. The time of lymphocytopenia recovery was shorter in A-I group than that in C-I group. 25 patients had elevated blood d-dimer level during ICU stay. Only one DVT case was found in C-I group, no significant differences were found. Discussion: Despite most of the patients with COVID-19 were thought to have a favorable prognosis, older patients and those with chronic underlying conditions may quickly develop severe pneumonia and progress to acute respiratory distress syndrome (ARDS) or multi-organ failure. An optimal treatment for severe or critically severe COVID-19 pneumonia is in urgent need. To our best knowledge, this is the first study that adopts the PR intervention into the treatment of severe or critically severe COVID-19 pneumonia. With good safety and feasibility, pulmonary rehabilitation intervention can bring benefits in the treatment. The novel pandemic brought the dilemma that most of the countries are facing now. The high contagiousness of COVID-19, extreme shortage of medical staffs and dangerous lack of medical equipment together brought great challenge to the medical system. With the whole devotion of our medical staffs and the whole country, we have now successfully restrained the epidemic in China. Hereby we urgently share our experience and hope it would be of some help to the medical staffs worldwide.