Recursos e técnicas fisioterapêuticas que devem ser utilizadas com cautela ou evitadas em pacientes com COVID-19*
Physiotherapeutic techniques that should be used with caution or avoided in patients with COVID-19*
Karina Couto Furlanetto, Nidia Aparecida Hernandes, Rafael Barreto de Mesquita
Resumo
O presente documento apresenta direcionamentos para o atendimento de Fisioterapia a pacientes com suspeita ou diagnostico de COVID-19, com foco nos recursos e técnicas que devem ser utilizados com cautela ou até mesmo evitados. Em meio à pandemia da COVID-19, a redução da disseminação do vírus é uma preocupação importante dos órgãos e profissionais de saúde. Deste modo, recomendações relacionadas ao risco para a geração de gotículas e aerossóis, ao risco de causar gasto energético excessivo e ao risco de causar injúria pulmonar foram apresentadas. Recomenda-se utilizar com cautela ou evitar o uso de máscara de Venturi, tenda de oxigênio, cânula nasal de alto fluxo, ventilação não-invasiva com circuito único, ressuscitador manual, exercícios físicos com intensidade moderada-alta, assim como estratégias convencionais de ventilação mecânica. O fisioterapeuta que assiste pacientes com COVID-19 deve observar esses direcionamentos para garantir um atendimento eficaz e seguro para si próprio e para o paciente.
Palavras-chave
Abstract
The current document provides guidelines for physiotherapy assistance to patients with suspected or diagnosed COVID-19, focusing on physiotherapy interventions that should be used with caution or even avoided. Amidst the COVID-19 pandemic, reducing the virus spread is a major concern for health agencies and healthcare professionals. Thus, recommendations related to the risk for generating aerosols, the risk of causing excessive energy expenditure and the risk of causing lung injury were provided. It is recommended to use with caution or avoid the use of Venturi mask, face tent oxygen mask, high flow nasal cannula, non-invasive ventilation with single circuit, hyperinflation bag system, moderate-to-high intensity physical exercises, as well as conventional mechanical ventilation settings. The physiotherapist who assists patients with COVID-19 must observe these guidelines to ensure an effective and safe care for both himself/herself and the patient.
Keywords
References
1. WHO/OMS. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance, 13 March 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 22]. Available from: https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf.
2. Brasil. Ministério da Saúde. Coronavírus: profissionais e gestores de saúde [Internet]. Brasília: Ministério da Saúde; 2020 [cited 2020 Mar 24]. Available from: https://coronavirus.saude.gov.br/.
3. WHO. Surface sampling of coronavirus disease (COVID-19): a practical “how to” protocol for health care and public health professionals [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Mar 23]. Available from: https://apps.who.int/iris/handle/10665/331058.
4. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother. 2020 Apr;66(2):73-82. doi: 10.1016/j.jphys.2020.03.011. Epub 2020 Mar 30.
5. Handbook of COVID-19 Prevention and Treatment [Internet]. London: ALNAP; 2020 Mar 18 [cited 2020 Mar 23]. Available from: https://www.alnap.org/help-library/handbook-of-covid-19-prevention-and-treatment.
6. ANVISA. Nota técnica GVIMS/GGTES/ANVISA nº 04/2020. Orientações para serviços de saúde: Medidas de prevenção e controle que devem ser adotadas durante a assistência aos casos suspeitos ou confirmados de infecção pelo novo Coronavírus (SARS-COV-2) [Internet]. Brasília: Agência Nacional de Vigilância Sanitária; 2020 [cited 2020 Mar 23]. Available from: https://www.amib.org.br/fileadmin/user_upload/amib/2020/marco/21/Nota_Tecnica_n_04-2020_GVIMS-GGTES-ANVISA-ATUALIZADA.pdf
7. AMIB. Orientações sobre o manuseio do paciente com pneumonia e insuficiência respiratória devido a infecção pelo Coronavírus (SARS-CoV-2) [Internet]. São Paulo: Associação de Medicina Intensiva Brasileira; 2020 [cited 2020 Mar 22]. Available from: http://www.amib.org.br/fileadmin/user_upload/amib/2020/marco/20/1_Orientacoes_sobre_o_manuseio_do_paciente_com_pneumonia_e_insuficiencia_respiratoria_devido_a_infeccao_pelo_Coronavirus_ai.pdf.
8. Strickland SL, Rubin BK, Drescher GS, Haas CF, O’Malley CA, Volsko TA, et al. AARC clinical practice guideline: effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients. Respir Care. 2013 Dec;58(12):2187-93. doi: 10.4187/respcare.02925.
9. Yang M, Yan Y, Yin X, Wang BY, Wu T, Liu GJ, et al. Chest physiotherapy for pneumonia in adults. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD006338. doi: 10.1002/14651858.CD006338.pub3.
10. Larsen T, Lee A, Brooks D, Michieli S, Robson M, Veens J, et al. Effect of Early Mobility as a Physiotherapy Treatment for Pneumonia: A Systematic Review and Meta-Analysis. Physiother Can. Winter 2019;71(1):82-89. doi: 10.3138/ptc.2017-51.ep
11. Bjorkqvist M, Wiberg B, Bodin L, Barany M, Holmberg H. Bottle-blowing in hospitaltreated patients with community-acquired pneumonia. Scand J Infect Dis. 1997;29(1):77-82. doi: 10.3109/00365549709008669.
12. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797. doi: 10.1371/journal.pone.0035797. Epub 2012 Apr 26.
13. Simonds AK, Hanak A, Chatwin M, Morrell M, Hall A, Parker KH, et al. Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess. 2010 Oct;14(46):131-172. doi: 10.3310/hta14460-02.
14. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020 Apr 16;382(16):1564-1567. doi: 10.1056/NEJMc2004973. Epub 2020 Mar 17.
15. Moses R. COVID 19: Respiratory Physiotherapy On Call Information and Guidance. Version 2 dated 14th March 2020 [Internet]. London: Chartered Society of Physiotherapy; 2020 [cited 2020 Mar 22]. Available from: https://www.csp.org.uk/system/files/documents/2020-03/COVID%2019%20Respiratory%20Physiotherapy%20On%20Call%20Information%20and%20Guidance%20V2. pdf. https://www.csp.org.uk/documents/coronavirus-respiratory-physiotherapy-call-guidance
16. Indicazione per la Fisioterapia respiratoria in pazienti con infezione da COVID-19, aggiornato al 16/03/2020 [Internet]. Roma: Associazione Riabilitatori dell’insufficienza Respiratoria; 2020 [cited 2020 Mar 23]. Available from: https://aifi.net/emergenza-covid-19-indicazioni-per-fisioterapisti-epazienti/
17. Grupo de Interesse em Fisioterapia Cardiorrespiratória. Fisioterapia respiratória em pessoas com COVID-19 [Internet]. [São Domingos de Rana]: Associação Portuguesa de Fisioterapeutas; 2020 May 4 [cited 2010 Mar 23]. Available from: https://www.gifcr-apf.com/
18. Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008 Jul;34(7):1188-99. doi: 10.1007/s00134-008-1026-7. Epub 2008 Feb 19.
19. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998 Feb 5;338(6):347-54. doi: 10.1056/NEJM199802053380602.
20. Amato MB, Meade MO, Slutsky AS, Brochard L,Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015 Jan 31;372(8):747-755. doi: 10.1056/nejmsa1410639
21. Guerin C, Papazian L, Reignier J, Ayzac L, Loundou A, Forel J-M. Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials. Crit Care. 2016 Nov 29;20(1):384. doi: 10.1186/s13054-016-1556-2.
22. Martinez BP, Andrade FMD, Roncalli A, Martins JA, Cavalheiro LV, Matte DL, et al. Intervenção na Insuficiência Respiratória Aguda. Comunicação Oficial COVID-19 ASSOBRAFIR [Internet]. São Paulo: ASSOBRAFIR, 2020 [cited 2020 Mar 23]. Available from: https://assobrafir.com.br/covid-19_vni/.
23. British Thoracic Society. COVID-19: information for the respiratory Community [Internet]. London: British Thoracic Society; 2020 [cited 2020 Mar 24]. Available from: https://www.britthoracic.org.uk/about-us/covid-19-information-for-the-respiratory-community/.
24. Physioplus. Respiratory Management of COVID 19. [cited 2020 Mar 22]. Available from: https://members.physio-pedia.com.
25. Han R, Huang L, Jiang H, Dong J, Peng H, Zhang D. Early Clinical and CT Manifestations of Coronavirus Disease 2019 (COVID-19) Pneumonia. AJR Am J Roentgenol. 2020 Aug;215(2):338-343. doi: 10.2214/AJR.20.22961. Epub 2020 Mar 17.
26. Arbillaga A, Pardàs M, Escudero R, Rodríguez R, Alcaraz V, Llanes S, et al. Fisioterapia respiratoria en el manejo del paciente con covid-19: recomendaciones generales. Versión 1 [Internet]. Barcelona: Sociedad Española de Neumología y Cirugía Torácica; 2020 Mar 26 [cited 2020 Apr 01]. Available from: http://svmefr.com/wp-content/uploads/2020/03/COVID19-SEPAR-26_03_20.pdf.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email