Safety and Efficacy of Chest Physiotherapy in Patients With COVID-19: A Critical Review

Auwal Abdullahi, Auwal Abdullahi

Abstract

The present global pandemic of COVID-19 has brought the whole world to a standstill, causing morbidity, death, and changes in personal roles. The more common causes of morbidity and death in these patients include pneumonia and respiratory failure, which cause the patients to require artificial ventilation and other techniques that can improve respiratory function. One of these techniques is chest physiotherapy, and this has been shown to improve gas exchange, reverse pathological progression, and reduce or avoid the need for artificial ventilation when it is provided very early in other respiratory conditions. For patients with COVID-19, there is limited evidence on its effect, especially in the acute stage and in patients on ventilators. In contrast, in patients after discharge, chest physiotherapy in the form of respiratory muscle training, cough exercise, diaphragmatic training, stretching exercise, and home exercise have resulted in improved FEV1 (L), FVC (L), FEV1/FVC%, diffusing lung capacity for carbon monoxide (DLCO%), endurance, and quality of life, and a reduction in anxiety and depression symptoms. However, there are still controversies on whether chest physiotherapy can disperse aerosols and accelerate the rate of spread of the infection, especially since COVID-19 is highly contagious. While some authors believe it is possible, others believe the aerosol generated by chest physiotherapy is not within respirable range. Therefore, measures such as the use of surgical masks, tele-rehabilitation, and self-management tools can be used to limit cross-infection.

Keywords: COVID-19; critical care; mortality; physiotherapy; pneumonia; ventilator.

Copyright © 2020 Abdullahi.

References

    1. Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID-19 based on current evidence. J Med Virol. (2020) 92:1–4. 10.1002/jmv.25722
    1. Zhao Y, Zhao Z, Wang Y, Zhou Y, Ma Y, Zuo W. Single-cell RNA expression profiling of ACE2, the putative receptor of Wuhan 2019-nCov. bioRxiv. (2020). 10.1101/2020.01.26.919985
    1. Castranova V, Rabovsky J, Tucker JH, Miles PR. The alveolar type II epithelial cell: a multifunctional pneumocyte. Toxicol Appl Pharmacol. (1988) 93:472–83. 10.1016/0041-008x(88)90051-8
    1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. (2020) 395:497–506. 10.1016/S0140-6736(20)30183-5
    1. Ahmed A, Shah RJ, Gul Rahim SEG, Flores M, O'Linn A. Coronavirus Disease 2019 (COVID-19) Complicated by Acute Respiratory Distress syndrome: an internist's perspective. Cureus. (2020) 12:e7482. 10.7759/cureus.7482
    1. Yang L-L, Yang T. Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19). Chronic Dis Transl Med. (2020) 6:79–86. 10.1016/j.cdtm.2020.05.002
    1. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. . Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. (2020) 395:507–13. 10.1016/S0140-6736(20)30211-7
    1. Guan WJ, Zhong NS. Clinical characteristics of COVID- 19 in China. N Engl J Med. (2020) 382:1859–62. 10.1056/NEJMc2005203
    1. 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) 305:1054–62. 10.1016/S0140-6736(20)30566-3
    1. Li X, Ma X. Acute respiratory failure in COVID-19: is it “typical” ARDS? Critical Care. (2020) 24:198. 10.1186/s13054-020-02911-9
    1. Alberti P, Beretta S, Piatti M, Karantzoulis A, Piatti ML, Santoro P, et al. . Guillain-Barré syndrome related to COVID-19 infection. Neurol Neuroimmunol Neuroinflamm. (2020) 7:e741. 10.1212/NXI.0000000000000741
    1. Virani A, Rabold E, Hanson T, Haag A, Elrufay R, Cheema T, et al. . Guillain-Barré Syndrome associated with SARS-CoV-2 infection [published online ahead of print, 2020 Apr 18]. IDCases. (2020) 20:e00771. 10.1016/j.idcr.2020.e00771
    1. Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. (2020) 19:383–4. 10.1016/S1474-4422(20)30109-5
    1. Padroni M, Mastrangelo V, Asioli GM, Pracucci G, Padroni M, Renieri L, et al. . Guillain-Barré syndrome following COVID-19: new infection, old complication? J Neurol. (2020) 267:1877–9. 10.1007/s00415-020-09849-6
    1. 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 Physiotherapy. (2020) 66:73–82. 10.1016/j.jphys.2020.03.011
    1. Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. . Guillain-Barre syndrome associated with SARS-CoV-2. N Eng J Med. (2020) 382:2574–76. 10.1056/NEJMc2009191
    1. Lazzeri M, Lanza A, Bellini R, Bellofiore A, Cecchetto S, Colombo A, et al. . Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. (2020) 90:163–7. 10.4081/monaldi.2020.1285
    1. Wong WP. Physical therapy for a patient in acute respiratory failure. Phys Ther. (2000) 80:662–70. 10.1093/ptj/80.7.662
    1. Wilson LM, Morrison L, Robinson KA. Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. (2019) 1:CD011231. 10.1002/14651858.CD011231.pub2
    1. Zhao H-M, Xie Y-X, Wang C. Recommendations for respiratory rehabilitation in adults with COVID-19. Chin Med J. (2020). 10.1097/CM9.0000000000000848
    1. Cooke FJ, Shapiro DS. Global outbreak of severe acute respiratory syndrome (SARS). Int J Infect Dis. (2003) 7: 80–5. 10.1016/S1201-9712(03)90001-4
    1. Simonds AK, Hanak A, Chatwin M, Morrell MJ, Hall A, Parker KH, et al. . Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess. (2010) 14:131–72. 10.3310/hta14460-02
    1. Brankston G, Gitterman L, Hiriji Z, Lemieux C, Gardam M. Transmission of influenza A in human beings. Lancet Infect Dis. (2007) 7:257–65. 10.1016/S1473-3099(07)70268-2
    1. Tellier R. Review of aerosol transmission of influenza A virus. Emerg Infect Dis. (2006) 12:1657–62. 10.3201/eid1211.060426
    1. Hui DS, Azhar IE, Madani TA, Ntoumi F, Kock R, Dar O, et al. . The continuing 2019-nCoV epidemic threat of novel coronaviruses to global healt h–the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. (2020) 91:264–66. 10.1016/j.ijid.2020.01.009
    1. Mehta SR, Sashindran VK, Kumar K, Gupta A. Severe acute respiratory syndrome: an update. Med J Armed Forces India. (2007) 63:52–5. 10.1016/S0377-1237(07)80110-9
    1. Adhikari SP, Meng S, Wu1 Y-J, Mao Y-P, Ye R-X, Wang Q-Z, et al. . Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty. (2020) 9:29. 10.1186/s40249-020-00646-x
    1. CDC 2019 Novel Coronavirus. Wuhan: (2020). Available online at: . (accessed April 1, 2020).
    1. Ott M, Milazzo A, Liebau S, Jaki C, Schilling T, Krohn A, et al. . Exploration of strategies to reduce aerosol-spread during chest compressions: a simulation and cadaver model. Resuscitation. (2020) 152:192–8. 10.1016/j.resuscitation.2020.05.012
    1. Liu K, Weitong Zhang W, Yang Y, Zhang J, Li Y, Chen Y. Respiratory rehabilitation in elderly patients with COVID-19: a randomized controlled study. Compl Therap Clin Pract. (2020) 39:101166. 10.1016/j.ctcp.2020.101166
    1. Castro AA, Calil SR, Freitas SA, Oliveira AB, Porto EF. Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients. Respir Med. (2013) 107:68–74. 10.1016/j.rmed.2012.09.016
    1. Ntoumenopoulos G, Presneill JJ, McElholum M, Cade JF. Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Med. (2002) 28:850–6. 10.1007/s00134-002-1342-2
    1. Kuyrukluyildiz U, Binici O, Kupeli I, Erturk N, Gulhan B, Akyol F, et al. . What is the best pulmonary physiotherapy method in ICU? Can Respir J. (2016) 2016:4752467. 10.1155/2016/4752467
    1. Cavalcanti AB, Suzumura EA, Laranjeira LN, Paisani DM, Damiani LP, Guimarães HP, et al. . Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. (2017) 318:1335–45. 10.1001/jama.2017.14171
    1. Thille AW, Contou D, Fragnoli C, Córdoba-Izquierdo A, Boissier F, Brun-Buisson C. Non-invasive ventilation for acute hypoxemic respiratory failure: intubation rate and risk factors. Crit Care. (2013) 17:R269. 10.1186/cc13103
    1. Bilan N, Poorshiri B. The role of chest physiotherapy in prevention of postextubation atelectasis in pediatric patients with neuromuscular diseases. Iran J Child Neurol. (2013) 7:21–4.

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