RONDÔNIA – Walking or lying on the stretcher, all victims of Covid-19 (new coronavirus) pass through the hands of physiotherapists. Infected patients find in the hospitals of Porto Velho and the State of Rondônia the support of these professionals, indispensable for the treatment and recovery of the disease.
Until Friday (25), the State Health Surveillance Agency (Agevisa) had more than 64,400 confirmed cases of Covid-19, of which 56,200 were recovered. Before, during and after their distressing moments of contagion, everyone was attended to and evaluated by these professionals.
They are the ones who receive people in care rooms, wards and hospital rooms, initiating clinical procedures to which technicians, nurses and doctors are joined.
The physiotherapist for seven years at the Center for Tropical Medicine (Cemetron), Ariel Souza Santos Felipe, celebrates the team’s victories, especially life. Some of his colleagues were attacked by the virus, but in a mild manner, however, they continued to help their patients for 24 hours.
“I have already faced the malaria crisis, the campaign against the H1N1 (swine) flu and now Covid-19, which is a God, help us, but it has brought us lessons and strengthened the union of our efforts”, he comments.
When Ariel Felipe started working at Cemetron, the team had only seven professionals in that area. Today there are 31. 24 emergencies have entered since the beginning of the pandemic, to serve two Intensive Care Units (ICUs), a ward, and the new block with coronavirus-exclusive patients.
Accelerate patient recovery. This is the challenge that this physiotherapist feels the need to face. “The patient must experience less severe pain, less sedation, or who has sequelae after hospitalization”, explains Ariel Felipe.
To combat these symptoms, respiratory parameters must be adjusted, adjusting the respiratory rate, tidal volume, positive pressure (which keeps the lungs in good condition), among others.
In a mixture of enthusiasm and emotion, Ariel reports the team’s work: “We are the only hospital in the state that offers respiratory therapies to the infected server, so that he can return to work more quickly; thank God, here, none of them died ”.
According to Ariel, two techniques are decisive in this respect: Non-Invasive Ventilation (NIV) and pronation (the person is placed face down). Patients in beds are connected to artificial respirators, while they are attended by health professionals protected by special clothes and masks.
“This procedure prevents the accumulation of secretion at the base of the lung, reactive to the airways and reduces the cardiac load. We have done this to exhaustion, using the face shield mask, which covers the entire face of the patient and guarantees the success of non-intubation ”, he adds.
In May this year, physiotherapist Rodrigo Campos, former director of the Rondônia Rehabilitation Center (Cero), recalled that intensive physiotherapy was not in evidence as it is today.
The activity is now more visible because of the pandemic
IMPORTANT IN NURSING
“Physiotherapy is also very important in the wards, where it contributes to improving the quality of life and reducing the average length of hospital stay,” says physiotherapist Eduardo Santos, who works at the Hospital de Campanha in Rondônia Zona Leste, in Porto Velho. This hospital works in the old Cero, in the Mariana district.
When the patient is infected with Covid-19, the physiotherapist’s job is to act to recover the patient as quickly as possible, reducing the need for medication and intubation, especially the risk of sequelae after hospitalization.
Eduardo explains how physical therapy works in Covid-19 times. “First, the physiotherapist makes an assessment of the infected person’s respiratory system to verify, mainly, the gas exchange of breathing, a main function of the respiratory system, and with that, identify the level of effort and the level of ventilatory support necessary, non-invasive ventilation as for invasive ventilation ”.
“If the infection is mild and the patient has good oxygenation in spontaneous ventilation outdoors, external assistance with breathing is not necessary, but constant monitoring of the evolution of the condition is essential, since there is a risk of accelerated complication. If the infection progresses to a case of respiratory failure, it is necessary to intervene, first of all, oxygen therapy devices (non-reinalining mask or NIV mask for non-invasive ventilation), or even a nasal catheter. an inspired fraction of oxygen more enriched, since the ambient air has only 21% oxygen ”, he says.
Pulmonary physiotherapy, on the other hand, allows so-called breathing and active motor exercises. “Respiratory exercise is a set of techniques that can be preventive or curative, and aim to mobilize secretions, improve blood oxygenation, promote pulmonary reexpansion, decrease respiratory work, re-educate the respiratory function and prevent complications”, explains physiotherapist Eduardo Santos.
MOTOR FUNCTIONS OF THE PATIENT
About 20% to 60% of patients admitted to the ICU develop generalized muscle weakness related to immobilization. In this way, motor physiotherapy aims to create more favorable conditions for the patient’s motor functions, avoiding contractures, deformities, muscle shortening, improving muscle strength and independence for activities of daily living.
“The service in the inpatient units is carried out following the guidelines for attire and de-attire, so professionals receive training and constant guidance offered by the institution”, he says.
According to physiotherapist Eduardo, the coronavirus can cause very large inflammation in the lungs, directly affecting gas exchange and, therefore, patients go into respiratory failure very quickly.
The physiotherapeutic procedure is divided into two areas: motor and respiratory. Motor is usually the best known. In the case of Covid-19, respiratory is of great importance within the ICU, as explained by Eduardo.
“This is where we started to make an assessment of the patient’s ventilatory pattern; if he is struggling, if he needs greater ventilatory support, we resort to oxygen therapy ”, he details.
Post-Covid-19 physiotherapy is also special for professionals in this area. “It is the transition from treatment, when the patient no longer needs mechanical assistance for breathing, and at this stage he must resume his autonomy to resume breathing on his own. In the second phase, motor physiotherapy enters, so that he recovers the muscle strength lost during treatment, in addition to improving bronchial hygiene, until, finally, normal breathing is possible without any assistance ”.
Eduardo recommends that, even after recovery and hospital discharge, the patient should do breathing exercises, mainly due to the possibility of sequelae. According to him, it is possible that some patients have respiratory limitations, developing a picture of pulmonary fibrosis and even need outpatient assistance.
Physical therapy helps to alleviate the symptoms caused by the disease. “Intensive care patients, especially those on ventilatory support, are the ones that require more vigilance”, says Eduardo.
“The physiotherapist assists in ventilatory surveillance and also devises strategies that reduce the time on the respirator as well as its complications; That is why I say that it is also important in the wards, where it ensures an improvement in the quality of life and a reduction in the average length of hospital stay ”, he adds.