How the COVID-19 infection tsunami revolutionized the work of respiratory physiotherapists: an experience from Northern Italy

  • Carla Simonelli Cardiac Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane, Italy. https://orcid.org/0000-0003-2238-7499
  • Mara Paneroni | mara.paneroni@icsmaugeri.it Pulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane, Italy. https://orcid.org/0000-0003-3982-2098
  • Aubin Georges Fokom Cardiac Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane, Italy.
  • Manuela Saleri Cardiac Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane, Italy.
  • Ilaria Speltoni Pulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane, Italy.
  • Irene Favero Pulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane, Italy. https://orcid.org/0000-0002-3164-7048
  • Francesca Garofali Pulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane, Italy.
  • Simonetta Scalvini Pulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane, Italy.
  • Michele Vitacca Cardiac Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane, Italy. https://orcid.org/0000-0002-9389-7915

Abstract

Due to COVID-19 outbreak, to lighten the burden of acute and critical care hospitals, some respiratory rehabilitation departments have been used to host patients with COVID-19 in the post-acute phase. This new and unexpected situation required a change of roles and scheduling of the rehabilitation teams. In this manuscript we describe the unexpected and urgent organizational change of the Cardio-Pulmonary Rehabilitation (CPR) service during the COVID-19 emergency in a Northern Italian rehabilitation hospital, focusing on the Respiratory Physiotherapists’ (RPTs) role. A quick three-days complete reorganization of the entire hospital was needed. A COVID-19 care team including a multidisciplinary panel of physicians, nurses, and RPTs was quickly performed to manage 90 beds for post acute patients with COVID-19. Within the team, the RPTs changed their shifts, so as to be available 16h per day, 7 days out of 7. Remodelled tasks in charge of RPTs were: oxygen therapy daily monitoring, non invasive ventilation (NIV) and continuous positive airways pressure (CPAP) delivery, pronation and postural changes to improve oxygenation, reconditioning with leg/arm cranking and exercises, initial and final patients’ functional assessment by short-physical performance battery (SPPB) and 1-minute sit-to-stand test (1-STS) to evaluate motor conditions and exercise-induced oxygen desaturation. Three “what-to-do” algorithms were developed to guide: i) oxygen de-escalation by reducing inhaled fraction of oxygen (FiO2); ii) oxygenation improvement through the use of Venturi mask; iii) reconditioning and physical activity. One-hundred seventy patients were treated in one month. As main topics, RPTs have been involved in oxygen therapy management in almost a third of the admitted patients, reconditioning exercises in 60% of the cases, and initial and final functional motor capacity assessment in all patients. Details of activities performed by the RPT in one typical working day are also shown. Our reorganization has exploited the professional skills and clinical expertise of the RPTs. This re-organization can provide practical insights to other facilities that are facing this crisis, and may be a starting point for implementing post-COVID-19 rehabilitation. Future studies will have to improve and review this organization.

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Published
2020-05-19
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Issue
Section
COVID-19 - Collection of articles on the Coronavirus outbreak
Keywords:
COVID, physiotherapist, respiratory physiotherapist, organization, rehabilitation outcome
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How to Cite
Simonelli, C., Paneroni, M., Fokom, A. G., Saleri, M., Speltoni, I., Favero, I., Garofali, F., Scalvini, S., & Vitacca, M. (2020). How the COVID-19 infection tsunami revolutionized the work of respiratory physiotherapists: an experience from Northern Italy. Monaldi Archives for Chest Disease, 90(2). https://doi.org/10.4081/monaldi.2020.1085