Feasibility of sit training for patients with severe COVID-19 pneumonia during deep sedation

Abstract

Rationale: There have been a few reports on the early rehabilitation of patients with coronavirus disease (COVID-19), and none on the effectiveness and adverse events of early mobilization for mechanical ventilation patients (other than COVID-19) during deep sedation. This report indicates that sitting without adverse events is possible in patients with severe COVID-19 pneumonia during deep sedation with muscle relaxation. Patient concerns: A 65-year-old man with a history of diabetes mellitus, lacunar infarction, and Parkinson's disease was admitted to a local hospital for pneumonia due to COVID-19. After admission, the patient was managed on a ventilator under deep sedation with muscle relaxants and sedatives. Twelve days after admission, the patient was transferred to our hospital due to his worsening respiratory status. Diagnosis: Pneumonia due to COVID-19 was diagnosed using a polymerase chain reaction–dependent method. Interventions: The day following transfer, a physical therapist started passive range of motion training and sitting. Outcomes: The period spanning his initial rehabilitation to muscle relaxant medication interruption was 9 days, and he underwent 7 rehabilitation sessions. The patient was unable to sit during only one of the 7 sessions due to pre-rehabilitation hypoxemia. In 5 of the 6 sitting sessions, PaO2/FiO2 transiently decreased but recovered by the time of subsequent blood sampling. The patient's PaCO2 decreased during all sessions. His blood pressure did not drastically decrease in any sitting session, except the first. Sputum excretion via sputum suction increased during sitting, and peak inspiratory pressure did not change. Lessons: The patient eventually died of pneumonia due to COVID-19. However, sitting during deep sedation with muscle relaxants did not cause any serious adverse events nor did it appear to cause obvious negative respiratory effects.

Case Report: Rehabilitation for Lower Extremity Pain Due to Venous Stasis in a Patient With Multisystem Inflammatory Syndrome in Children

“…Several studies have reported rehabilitation for patients with COVID-19 pneumonia (14)(15)(16)(17)(18). However, to the best of our knowledge, there have been no reports of rehabilitation for patients with MIS-C.…”

Complications Associated with Preventive Management to Reduce the Risk of COVID-19 Spread After Surgery for Spinal Cord Injury

“…Excessive fluid replacement to correct the decrease in circulating plasma volume can cause pulmonary edema. However, previous studies have noted that early gravity loading in a sitting or standing position, with an abdominal bandage and elastic stockings as an active rehabilitation intervention, may increase the circulating plasma volume and prevent the occurrence of symptomatic pulmonary edema 31,32 . In addition, physical therapy interventions such as positional drainage for atelectasis can prevent symptomatic respiratory failure or pneumonia by improving the patient’s airway clearance 33 .…”

The Effects of Early Rehabilitation in the Intensive Care Unit for Patients with Severe COVID-19 Pneumonia: A Retrospective Cohort Study

“…Early mobilization of ICU patients effectively reduces the time to extubation and duration of hospital stay and improves the ADL [7]. Additionally, early rehabilitation has been recently recommended for patients with COVID-19 in the ICU [5,8,9]. Despite numerous concerns regarding the rehabilitation of patients with severe COVID-19 pneumonia, a consensus has been reached on several fronts, including respiratory training, moderate head elevation, limb mobilization, and sitting and standing positions at the bedside [18].…”

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