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Research ArticleOriginal Research

Systemic and Cerebral Effects of Physiotherapy in Mechanically Ventilated Subjects

Denise Battaglini, Elena Ciaravolo, Salvatore Caiffa, Lara Delpiano, Lorenzo Ball, Antonio Vena, Daniele R Giacobbe, Matteo Bassetti, Basil Matta, Paolo Pelosi and Chiara Robba on behalf of the GECOVID Collaborators
Respiratory Care February 2023, respcare.10227; DOI: https://doi.org/10.4187/respcare.10227
Denise Battaglini
Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Medicine, University of Barcelona, Barcelona, Spain.
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  • For correspondence: [email protected]
Elena Ciaravolo
Anesthesia and Emergency Department, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
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Salvatore Caiffa
Intensive Care Respiratory Physiotherapy, Rehabilitation and Functional Education, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
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Lara Delpiano
Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
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Lorenzo Ball
Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
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Antonio Vena
Department of Health Sciences, University of Genoa, Genoa, Italy; and Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
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Daniele R Giacobbe
Department of Health Sciences, University of Genoa, Genoa, Italy; and Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
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Matteo Bassetti
Department of Health Sciences, University of Genoa, Genoa, Italy; and Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
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Basil Matta
Neurocritical Care Unit, Addenbrooke’s Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom.
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Paolo Pelosi
Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
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Chiara Robba
Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
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Abstract

BACKGROUND: Physiotherapy may result in better functional outcomes, shorter duration of delirium, and more ventilator-free days. The effects of physiotherapy on different subpopulations of mechanically ventilated patients on respiratory and cerebral function are still unclear. We evaluated the effect of physiotherapy on systemic gas exchange and hemodynamics as well as on cerebral oxygenation and hemodynamics in mechanically ventilated subjects with and without COVID-19 pneumonia.

METHODS: This was an observational study in critically ill subjects with and without COVID-19 who underwent protocolized physiotherapy (including respiratory and rehabilitation physiotherapy) and neuromonitoring of cerebral oxygenation and hemodynamics. PaO2/FIO2, PaCO2, hemodynamics (mean arterial pressure [MAP], mm Hg; heart rate, beats/min), and cerebral physiologic parameters (noninvasive intracranial pressure, cerebral perfusion pressure using transcranial Doppler, and cerebral oxygenation using near-infrared spectroscopy) were assessed before (T0) and immediately after physiotherapy (T1).

RESULTS: Thirty-one subjects were included (16 with COVID-19 and 15 without COVID-19). Physiotherapy improved PaO2/FIO2 in the overall population (T1 = 185 [108–259] mm Hg vs T0 = 160 [97–231] mm Hg, P = .019) and in the subjects with COVID-19 (T1 = 119 [89–161] mm Hg vs T0 = 110 [81–154] mm Hg, P = .022) and decreased the PaCO2 in the COVID-19 group only (T1 = 40 [38–44] mm Hg vs T0 = 43 [38–47] mm Hg, P = .028). Physiotherapy did not affect cerebral hemodynamics, whereas increased the arterial oxygen part of hemoglobin both in the overall population (T1 = 3.1% [−1.3 to 4.9] vs T0 = 1.1% [−1.8 to 2.6], P = .007) and in the non-COVID-19 group (T1 = 3.7% [0.5–6.3] vs T0 = 0% [−2.2 to 2.8], P = .024). Heart rate was higher after physiotherapy in the overall population (T1 = 87 [75–96] beats/min vs T0 = 78 [72–92] beats/min, P = .044) and in the COVID-19 group (T1 = 87 [81–98] beats/min vs T0 = 77 [72–91] beats/min, P = .013), whereas MAP increased in the COVID-19 group only (T1 = 87 [82–83] vs T0 = 83 [76–89], P = .030).

CONCLUSIONS: Protocolized physiotherapy improved gas exchange in subjects with COVID-19, whereas it improved cerebral oxygenation in non-COVID-19 subjects.

  • respiratory physiotherapy
  • rehabilitation
  • neurological complications
  • hemodynamic monitoring
  • oxygenation

Footnotes

  • Correspondence: Denise Battaglini MD, Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132, Genoa, Italy. E-mail: battaglini.denise{at}gmail.com
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Respiratory Care: 68 (4)
Respiratory Care
Vol. 68, Issue 4
1 Apr 2023
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Systemic and Cerebral Effects of Physiotherapy in Mechanically Ventilated Subjects
Denise Battaglini, Elena Ciaravolo, Salvatore Caiffa, Lara Delpiano, Lorenzo Ball, Antonio Vena, Daniele R Giacobbe, Matteo Bassetti, Basil Matta, Paolo Pelosi, Chiara Robba
Respiratory Care Feb 2023, respcare.10227; DOI: 10.4187/respcare.10227

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Systemic and Cerebral Effects of Physiotherapy in Mechanically Ventilated Subjects
Denise Battaglini, Elena Ciaravolo, Salvatore Caiffa, Lara Delpiano, Lorenzo Ball, Antonio Vena, Daniele R Giacobbe, Matteo Bassetti, Basil Matta, Paolo Pelosi, Chiara Robba
Respiratory Care Feb 2023, respcare.10227; DOI: 10.4187/respcare.10227
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Keywords

  • respiratory physiotherapy
  • rehabilitation
  • neurological complications
  • hemodynamic monitoring
  • oxygenation

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