Physiotherapeutic intervention in the intensive care unit for SARS-VOC-2 patients: challenges and innovations of invasive mechanical ventilation

Authors

  • Noemi Moreira Reis Centro Universitário AGES, Paripiranga, Bahia
  • Fábio Luiz Oliveira de Carvalho Centro Universitário AGES, Paripiranga, Bahia

DOI:

https://doi.org/10.20952/jrks1111648

Abstract

The present work brings with it an analysis about the physiotherapeutic treatment in the patient submitted to invasive mechanical ventilation, resulting from the acute respiratory distress syndrome - SARA, originating from COVID-19, which is characterized by a viral infection and affects the airways, mainly, epithelial, alveolar and endothelial cells, thus causing the presence of multinucleate, syncytial cells and atypical pneumocytes between the alveoli, due to viral changes. Thus, the most severe forms of the disease demonstrate the inflammatory cascade that defines ARDS, through the presence of inflammatory infiltrates and alveolar and interstitial edema. In this sense, this study has the general objective of understanding how physiotherapy intervenes in the intensive care environment, compared to patients diagnosed with SARS-CoV-2, who are on invasive mechanical ventilation. Therefore, the research methodology is characterized as an integrative literature review, collecting information in the Google Scholar databases, Medline (PubMed), LILACS, SciELO, PEDro, using as Health Sciences Descriptors: “Respiratory Distress Syndrome, Adult” “Respiratory Insufficiency” “Artificial respiration” and “COVID-19”, with time limits from 2010 to 2020 for articles. The results of research indicate that invasive mechanical ventilation is essential for maintaining the life of patients with ARDS, so they take protective ventilation in order to avoid further lung damage, through ventilation adjustments, which can be volume or pressure. It was also seen about prone ventilation, which seeks to improve the oxygenation rate and decrease mortality levels. In this context, it can be concluded that most of the articles found in this review corroborate the importance of the physiotherapist's performance in the ICU and his aptitude for the management of invasive mechanical ventilation, in order to promote improvement and discharge from this environment, as well as the relevance of mechanical ventilation stresses, which, by means of appropriate adjustments, provides a reduction in hypoxemia and, consequently, offers imminent improvement to patients undergoing it.

References

ALBORNOZ, P.V.R. et al. Posición prona en el síndrome de distrés respiratorio agudo grave. Revista de la Asociación Mexicana de Medicina Crítica y Terapia Intensiva, v. 30, n. 4, p. 235-241, 2016.

ANANIAS, M.A.N.B.; CAMBRAIA, A.A.; CALDERARO, D.C. Efeito da posição prona na mecânica respiratória e nas trocas gasosas em pacientes com SDRA grave. Rev Med Minas Gerais, v. 28, 2017.

ARBILLAGA, A. et al. Fisioterapia respiratoria en el manejo del paciente con covid-19: recomendaciones generales. SEPAR, versión 1.0, 26 de marzo 2020.

ARIZAGA, A. S. Aportaciones de la fisioterapia respiratoria como terapia adyuvante en pacientes con COVID-19 ingresados en UCI; una oportunidad de desarrollo. Gaceta Médica de Bilbao, v. 117, n. 2, p. 168-173, 2020.

BARBOSA, L. D. O uso de ventiladores na pandemia do COVID-19. InterAmerican Journal of Medicine and Health, v. 3, 2020.

CHACKO, B. et al. Ventilação controlada por pressão versus ventilação controlada por volume para insuficiência respiratória aguda devido a lesão pulmonar aguda (LPA) ou síndrome do desconforto respiratório agudo (SDRA). Cochrane Database of Systematic Reviews, n. 1, 2015.

DANTAS, M. et al. Contribuições das áreas: Farmácia, Fisioterapia e Psicologia aos pacientes internados em UTIs por COVID-19. Health Residencies Journal-HRJ, v. 1, n. 5, p. 75-91, 2020.

ESTEVÃO, A. COVID-19. Acta Radiológica Portuguesa, v. 32, n. 1, p. 5-6, 2020.

FERRANDO, C. et al. Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive care medicine, p. 1-12, 2020.

FICHTNER, F. et al. Mechanical ventilation and extracorporeal membrane oxygenation in acute respiratory insufficiency. Deutsches Ärzteblatt International, v. 115, n. 50, p. 840, 2018.

FREDES, S. et al. Effect of PEEP on inspiratory resistance components in patients with acute respiratory distress syndrome ventilated at low tidal volume. Revista Brasileira de Terapia Intensiva, v. 31, n. 4, p. 483, 2019.

GUÉRIN, C. et al. Prone positioning in severe acute respiratory distress syndrome. New England Journal of Medicine, v. 368, n. 23, p. 2159-2168, 2013.

GUIMARÃES, F. Atuação do fisioterapeuta em unidades de terapia intensiva no contexto da pandemia de COVID-19. Fisioter. Mov., Curitiba, v. 33, 2020.

HERRMANN, J. et al. Shared ventilation in the era of covid-19: A theoretical consideration of the dangers and potential solutions. Respiratory Care, v. 65, n 7, 2020.

MATOS, L. A. D.; FARIAS, D. H.; CALLES, A. C. N. O uso da ventilação mecânica e terapia adjuvante em pacientes portadores da síndrome de angústia respiratória aguda (sara): uma revisão integrativa. Caderno de Graduação-Ciências Biológicas e da Saúde-UNIT-ALAGOAS, v. 4, n. 3, p. 111, 2018.

MCGUINNESS, G. et al. Increased Incidence of Barotrauma in Patients with COVID-19 on Invasive Mechanical Ventilation. Radiology, v. 297, n. 2, p. E252-E262, 2020.

MENDES, B. S. et al. COVID-19 & SARS. Revista Ulakes, v. 1, 2020.

MOGUEL, K. G. P. et al. Ventilación mecánica en decúbito prono: estrategia ventilatoria temprana y prolongada en SIRA severo por influenza. Medicina Crítica, v. 31, n. 4, p. 198-204, 2017.

PARK, S. Y. et al. The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. Journal of thoracic disease, v. 7, n. 3, p. 356, 2015.

PEGADO, R. et al. Doença coronavírus 2019 (COVID-19) no Brasil: informações para fisioterapeutas. Revista da Associação Médica Brasileira, v. 66, n. 4, pág. 498-501, 2020.

SEIBERLICH, E. et al. Ventilação mecânica protetora, por que utilizar?. Revista Brasileira de Anestesiologia, v. 61, n. 5, p. 663-667, 2011.

SOUZA, M. T.; SILVA, M. D.; CARVALHO, R. Revisão integrativa: o que é e como fazer. Einstein (São Paulo), v. 8, n. 1, p. 102-106, 2010.

SUD, S. et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. CmAj, v. 186, n. 10, p. E381-E390, 2014.

WINDISCH, W. et al. Ventilação invasiva e não invasiva em pacientes com COVID-19. Deutsches Arzteblatt International, v. 117, n. 31-32, pág. 528-533, 2020.

YU, Y. et al. Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study. Critical Care, v. 24, p. 1-10, 2020.

ZHOU, Y. et al. A aplicação precoce de ventilação de liberação de pressão nas vias aéreas pode reduzir a duração da ventilação mecânica na síndrome do desconforto respiratório agudo. Medicina de terapia intensiva, v. 43, n. 11, pág. 1648-1659, 2017.

Published

30/12/2020

Issue

Section

Health Sciences