Crisafulli Oscar, Baroscelli Marta, Grattarola Luca, Tansini Giuseppe, Zampella Cristian, D'Antona Giuseppe
CRIAMS-Sport Medicine Centre Voghera, University of Pavia, Voghera, Italy.
Oncology Unit Casalpusterlengo, Ospedale Maggiore di, Lodi, Italy.
Front Physiol. 2022 Nov 17;13:1035255. doi: 10.3389/fphys.2022.1035255. eCollection 2022.
COVID-19 may require hospitalization in an intensive care unit (ICU) and is often associated with the onset of critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Due to the spread of the disease around the world, the identification of new rehabilitation strategies for patients facing this sequence of events is of increasing importance. We report the clinical presentation and the beneficial effects of a prolonged, supervised adapted motor activity (AMA) program in a highly deconditioned 61-year-old male COVID-19 patient discharged from the ICU and complicated by residual CIP and CIM. The program included aerobic, strength, gait, and balance training (1 h, 2 sessions per week). Pulmonary (spirometry), metabolic (indirect calorimetry and bioimpedance), and neuromuscular functions (electromyography) were evaluated at baseline and after 1 year of training. Relative to baseline, an amelioration of several spirometric parameters such as vital capacity (VC, +40%), total lung capacity (TLC, +25%), and forced expiratory volume in 1 s (FEV1, +28%) was appreciable. Metabolic parameters such as body water (60%-46%), phase angle (3.6°-5.9°), and respiratory quotient (0.92-0.8) returned to the physiological range. Electromyographic parameters were substantially unchanged. The overall amelioration in clinical parameters resulted in a significant improvement of patient autonomy and the quality of life. Our results highlight the importance of AMA for counteracting respiratory, metabolic, and functional but not neuromuscular impairments in COVID-19 patients with residual CIM and CIP.
新型冠状病毒肺炎（COVID-19）可能需要入住重症监护病房（ICU），且常伴有危重病性多发性神经病（CIP）和危重病性肌病（CIM）的发生。由于该疾病在全球范围内传播，确定针对面临这一系列情况的患者的新康复策略变得越来越重要。我们报告了一名61岁、身体状况极差的男性COVID-19患者的临床表现以及一项长期、有监督的适应性运动活动（AMA）计划的有益效果，该患者从ICU出院后并发残留CIP和CIM。该计划包括有氧运动、力量训练、步态训练和平衡训练（每周2次，每次1小时）。在基线时以及训练1年后评估了肺部（肺功能测定）、代谢（间接测热法和生物电阻抗）和神经肌肉功能（肌电图）。相对于基线，肺活量（VC，增加40%）、肺总量（TLC，增加25%）和1秒用力呼气量（FEV1，增加28%）等几个肺功能测定参数有明显改善。身体水分（60% - 46%）、相位角（3.6° - 5.9°）和呼吸商（0.92 - 0.8）等代谢参数恢复到生理范围。肌电图参数基本未变。临床参数的总体改善导致患者自主性和生活质量显著提高。我们的结果强调了AMA对于对抗残留CIM和CIP的COVID-19患者的呼吸、代谢和功能障碍而非神经肌肉损伤的重要性。
