Rehabilitación respiratoria oportuna y precoz en pacientes con neumonía covid-19 en un hospital
CARTA AL EDITOR
REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2021 - Universidad
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
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
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,
Respiratory rehabilitation is a tool used by the clinician to improve the physical and psychological
condition and quality of life of people suffering from chronic respiratory disease. It is based on
individualized management of the patient by applying muscle training, physiotherapy techniques, education,
psychological and nutritional evaluation.(5)
Respiratory rehabilitation applied in
a timely and early manner reduces dyspnea, relieves anxiety and depression. In addition, it could reduce the
occurrence of respiratory complications, improve pulmonary dysfunction and reduce the disability rate of
hospitalized patients with a diagnosis of moderate to severe COVID-19 at the end of the acute phase.
For aerobic exercises, an extremity cycloergometer is used, with oxygen support to ensure an
) greater than 95%, controlled according to the Borg scale and safety heart
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
Tabla 1. Early Respiratory Rehabilitation of moderate to severe COVID-19
|Criteria for initiation of early respiratory rehabilitation
||Prescription of early respiratory rehabilitation exercises COVID-19
- Basal FiO2 requirement ≤ 40% (binasal cannula).
- Respiratory rate < 25rpm
- Rhythmic heart rate < 100lpm
- Temperature < 38°C
- SatO2 > 94%.
- Systolic blood pressure > 90mmHg
- Mean arterial blood pressure > 70mmHg
- Time to onset of illness 10 - 14 days
- Borg resting scale < 3 points
*PEP device, Threshold IMT as required.
- Early sitting out of bed.
- 10 minutes warm-up with isotonic movements of limbs, torso and head; accompanied
by diaphragmatic breathing and pursed lip.
- Start of limb ergometer, monitoring Borg scale (<7 points) and maintain
target heart rate (64% - 76% of maximal HR value -defined as 220 - age of
patient-).For 30 minutes, continuous or intermittent (progressive goals).
*Oxygen support for SatO2 > 94% (pre-during-post exercise).
- 10-minute cool-down and rest.
- Start of incentive inspirometer (contraindicated in obstructive pattern): 20
inspirations 1 minute apart (progressive targets).
*Duration 1 week in-hospital (re-evaluation), complete two months at home.
|Criterios de finalización
FiO2: Inspired fraction of O2. SatO2: O2
saturation. Maximum HR: Maximum heart rate. PEP:
Positive expiratory pressure.
- Borg dyspnea scale > 7 (total score: 10 points).
- Anterior chest tightness, dizziness, headache, palpitations, diaphoresis,
- Sustained desaturation
- Decrease in SatO2 > 4 points from basal for more than 1
- Decrease in O2 < 88% for more than 1 minute.
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.
Vásquez García, Efecto del tiempo de exposición a pantallas de visualización
de datos sobre la fatiga visual en digitadores del HNGAI –EsSALUD. UNIVERSIDAD NACIONAL MAYOR DE
SAN MARCOS. FACULTAD DE MEDICINA. UNIDAD DE POST GRADO. https://cybertesis.unmsm.edu.pe/handle/20.500.12672/2080
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