60 天：巴西将神经外科中心改造成 COVID-19 中心后的物理治疗

The First 60 Days: Physical Therapy in a Neurosurgical Center Converted Into a COVID-19 Center in Brazil.

机构信息

Department of Physical Therapy, Instituto Estadual do Cérebro Paulo Niemeyer, Rua do Resende, 156, Rio de Janeiro, RJ 20231-092, Brazil.

Department of Physical Therapy, Instituto Estadual do Cérebro Paulo Niemeyer.

出版信息

Phys Ther. 2020 Dec 7;100(12):2120-2126. doi: 10.1093/ptj/pzaa175.

DOI:10.1093/ptj/pzaa175

PMID:32941641

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7543618/

Abstract

OBJECTIVE

The purpose of this case report was to describe the role of physical therapists in a neurosurgical center that was converted into a COVID-19 center for critically ill patients.

METHODS (CASE DESCRIPTION): On March 16, 2020, the state government of Rio de Janeiro, Brazil, determined that a neurosurgical center with 44 ICU beds equipped with mechanical ventilators should immediately transfer all patients with neurological conditions to other institutions and prepare for patients who were critically ill with COVID-19. The staff, including physical therapists, were trained to handle patients with COVID-19, many of whom were developing acute respiratory distress syndrome (ARDS) with complex and multifactorial ventilatory support needs. Adjustments were made to the physical therapy routine and protocols. Following the stabilization of patients' respiratory condition, physical therapist interventions focused on restoring physical function.

RESULTS

A total of 116 confirmed COVID-19 cases were treated from March 17 to May 17, 2020. Sixty percent were men (70) and 40% were women (46), with a median age of 59 years. Eighty-nine percent (103) underwent mechanical ventilation during hospitalization, of which 11% (11) were successfully extubated. Thirty percent (31) of patients underwent tracheostomy, and 26% of those (8) were successfully decannulated. Of the total patients, 57 patients died (mortality rate of 49%), 4 (3%) were transferred to another institution, 23 (20%) were discharged home, and 32 (28%) continued to be hospitalized.

CONCLUSION

Physical therapists in the ICU can facilitate care for critical events such as intubation, patient positioning, ventilatory adjustments, extubation, and functional training.

IMPACT

The coronavirus pandemic has highlighted the importance of physical therapists, specifically in the care of patients who are critically ill with COVID-19. The availability and expertise of physical therapists in the ICU are important for managing critical events such as intubation, patient positioning, ventilatory adjustments, extubation, and functional training.

摘要

目的

本病例报告旨在描述在一家神经外科中心转变为危重症 COVID-19 患者中心的情况下，物理治疗师所扮演的角色。

方法（病例描述）：2020 年 3 月 16 日，巴西里约热内卢州政府决定将一家拥有 44 张配备有机械呼吸机的 ICU 床位的神经外科中心立即将所有神经科疾病患者转移至其他机构，并为患有 COVID-19 的危重症患者做好准备。包括物理治疗师在内的工作人员接受了处理 COVID-19 患者的培训，其中许多患者患有急性呼吸窘迫综合征（ARDS），需要复杂且多因素的通气支持。物理治疗常规和方案进行了调整。在患者呼吸状况稳定后，物理治疗师的干预重点是恢复身体功能。

结果

2020 年 3 月 17 日至 5 月 17 日期间共收治了 116 例确诊的 COVID-19 病例。60%为男性（70 例），40%为女性（46 例），中位年龄为 59 岁。89%（103 例）在住院期间接受了机械通气，其中 11%（11 例）成功拔管。30%（31 例）的患者接受了气管切开术，其中 26%（8 例）成功脱管。总共有 57 例患者死亡（死亡率为 49%），4 例（3%）转至其他机构，23 例（20%）出院回家，32 例（28%）继续住院。