Approach to the critical adult patient with covid-19 Abordaje del paciente adulto crítico con covid-19 Physioterapy perspective

Abstract

Objective: Compile information on the approach to critical adult patients with COVID-19 from a physiotherapeutic perspective. Method: A literature review was carried out researching and reviewing original articles and secondary sources according to a selection criterion, using databases as: Medline, Embase, Pubmed, NCBI, Elsevier, Science Direct, Dial net, with publications up to July 2020. Results: 576 publications were found: 491 were excluded, 85 were primary sources that met the inclusion criteria, 53 of them were review documents, 17 observational studies, 5 clinical trials, 4 case studies and 6 systematic reviews; which addressed topics such as: Classification of phenotypes in COVID 19, personal protective equipment (PPE), oxygen therapy, high flow nasal cannula (CNAF), non-invasive mechanical ventilation (NIMV), conscious prone position, pulmonary rehabilitation, orotracheal intubation (IOT), sedative analgesia, neuromuscular blockers, pulmonary protection, ventilatory mechanics, alveolar recruitment maneuvers, prone position, early mobilization and therapeutic exercise, spontaneous ventilation in invasive mechanical ventilation (IMV), weaning and extubating, other therapies and interventions. Conclusions: The PPE, lung protection strategies guaranteed by adequate ventilatory monitoring and oxygenation goals, characterization of the COVID 19 phenotype and therapeutic exercise, have a predominant role in the treatment of patients with COVID 19, therefore, the physiotherapist must know how this strategies impact in his therapeutic objectives and thus in the clinical outcome