Elmer Nancy, Liebl Max Emanuel, Schwedtke Christine, Drebinger Daniel, Reißhauer Anett
Physikalische Medizin und Rehabilitation, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
Z Rheumatol. 2022 Jun;81(5):386-392. doi: 10.1007/s00393-022-01178-5. Epub 2022 Mar 22.
While the first wave of the coronavirus disease 2019 (COVID-19) pandemic mainly affected the old, currently younger patients also become infected and hospitalized. After severe and critical COVID-19 infections and also after surviving acute phase symptoms, these patients often show symptoms (e.g. exertional dyspnea), organ damage (e.g. of the lungs, the cardiovascular system) as well as psychological impairments.
The severe courses after critical cases of COVID-19 represent challenges for rehabilitation and require more than ever rehabilitative treatment approaches even in acute hospitals.
This article presents a selected case series of patients with a typical constellation of pre-existing conditions due to immunosuppression plus critical course of COVID-19 and indications for acute rehabilitation.
This case series depicts the long duration of hospitalization with high numbers of hours on ventilation in the intensive care unit. At the time of transfer to acute rehabilitation these patients are immobile and have severe limitations in all activities of daily life, so that an inpatient rehabilitation in an acute hospital is indicated and the usual means of continuation of rehabilitation were not feasible. The sequelae of lying prone and complications, such as exertional desaturation in the early stage of convalescence are detected in the acute phase of early rehabilitation.
After severe COVID-19 infections new challenges for rehabilitation are to be expected, so that rehabilitative treatment approaches with an interdisciplinary early rehabilitation in an acute hospital are urgently needed. Finally, acute rehabilitation not only enables a seamless treatment chain for these patients but also the flow of patients from the intensive care unit to ensure the functioning of local infrastructures.
虽然2019冠状病毒病(COVID-19)大流行的第一波主要影响老年人,但目前年轻患者也受到感染并住院。在经历严重和危重型COVID-19感染以及急性期症状存活后,这些患者常出现症状(如运动性呼吸困难)、器官损害(如肺部、心血管系统)以及心理障碍。
COVID-19危重症病例后的严重病程给康复带来挑战,即使在急性医院也比以往更需要康复治疗方法。
本文介绍了一系列因免疫抑制加上COVID-19危重症病程以及有急性康复指征而具有典型合并症的患者。
该病例系列描述了住院时间长,在重症监护病房接受大量小时数的通气治疗。在转至急性康复时,这些患者行动不便,日常生活的所有活动都有严重限制,因此需要在急性医院进行住院康复,而常规的康复延续方式并不可行。在早期康复的急性期检测到俯卧后遗症和并发症,如恢复期早期运动性低氧血症。
严重COVID-19感染后预计会出现新的康复挑战,因此迫切需要在急性医院采用跨学科早期康复的康复治疗方法。最后,急性康复不仅为这些患者提供了无缝的治疗链,还实现了患者从重症监护病房的流转,以确保当地基础设施的正常运转。