CARTA AL EDITOR
REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2021 - Universidad Ricardo Palma10.25176/RFMH.v21i4.3821
REHABILITACIÓN RESPIRATORIA OPORTUNA Y PRECOZ EN PACIENTES CON NEUMONÍA COVID-19 EN UN HOSPITAL REFERENCIAL.
TIMELY AND EARLY RESPIRATORY REHABILITATION IN PATIENTS WITH COVID 19 PNEUMONIA IN A REFERRAL HOSPITAL
Antonio O. Morales Avalos1 , Félix K. Llanos Tejada1,2 , Juan A. Salas Lopez1,3 , Aldo R. Casanova Mendoza1,3
1 Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
2 Facultad de medicina Humana, Universidad Ricardo Palma, Lima, Perú
3 Facultad de medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú
Mr. Editor
SARS-CoV-2 is a beta-coronavirus of the same subgenus as SARS and MERS viruses, they share the
same gene binding receptor, angiotensin converting enzyme (ACE2). (1) The
spectrum of disease severity is varied, with the mild form being the most frequent (81%), and severe
disease present in 14% of cases, with critical presentation being present in 5%, with a mortality of
2.3%.(2)
The post-pneumonia respiratory sequela caused by beta-Coronaviruses is diffuse alveolar damage
with fibrotic lesions; the pathophysiological mechanism is multifactorial, which involves activation of
transforming growth factor beta (TGF-β)(3), IL1, IL6, MCP1 and TNF-α secondary
to epithelial injury and subsequent inflammation. In addition, exposure to high O2 concentrations and
effects of barotrauma, caused by advanced oxygen/ventilatory support, activate the pro-fibrotic TGF-β
pathway, resulting in aberrant repair characterized by exaggerated deposition of fibroblasts,
myofibroblasts and collagen. Forty-seven percent and 25% of patients who survive moderate to severe
COVID-19 pneumonia have decreased carbon monoxide diffusion and predicted total lung capacity,
respectively. (4)
For aerobic exercises, an extremity cycloergometer is used, with oxygen support to ensure an O2 saturation (SatO2) greater than 95%, controlled according to the Borg scale and safety heart rate. In addition, it is suggested to use an incentive inspirometer, by flow or volume, considering that the pulmonary sequelae are of restrictive pattern. As for the initial and follow-up evaluation parameters, it is suggested to use the one-minute standing-sitting test or the desaturation test with walking.
Our pulmonology team of a referral hospital for COVID-19 management suggests starting the post-COVID-19 respiratory rehabilitation program as follows (Table 1).
Tabla 1. Early Respiratory Rehabilitation of moderate to severe COVID-19 pneumonia.
| Criteria for initiation of early respiratory rehabilitation | Prescription of early respiratory rehabilitation exercises COVID-19 |
|---|---|
|
*Duration 1 week in-hospital (re-evaluation), complete two months at home. *Nutritional evaluation *Psychological evaluation |
| Criterios de finalización | |
|
Authorship contributions: AMA, FLT, JSL y ACM have participated in the preparation of the
letter to the editor and the approval of its final version.
Funding sources: Self-funded
Conflicts of Interests: The authors declare that there is no conflict of interest.
Received: 04 May, 2021
Approved: 10 August, 2021
Correspondence: Antonio Omar Morales Avalos
Address: Jr. Huiracocha 1852 Jesús María, Lima – Perú.
Telephone: +51 989112109.
Email: neumorales22@gmail.com
REFERENCES
