Reabilitação de pacientes com sequelas decorrentes da infecção por Covid-19

Abstract

Introduction: In December 2019, a pneumonia outbreak with a new strain of coronavirus began in China. In Brazil, up to the date of the study, there were 37,519,960 confirmed cases, with 702,116 deaths. The disease is caused by the SARS-CoV-2 virus and is named COVID-19. While some infected individuals develop mild flu-like symptoms, a minority transition to a more severe stage of the disease. Abnormal clinical signs and symptoms may persist for a long time and be considered effects and/or sequelae of the disease. These sequelae evolve with physical limitations, requiring personalized rehabilitation with non-pharmacological strategies such as physical training. Objective: To evaluate the effects of a cardiopulmonary rehabilitation program (CPRP) in patients with different types of post-COVID-19 infection sequelae. Methods: In this dissertation, we present two articles: 1st case report: Elderly patient, male, hypertensive, who participated in a supervised home CPRP after presenting sequelae from severe COVID-19 infection, submitted to intensive care unit admission and orotracheal intubation; 2nd Clinical, retrospective, quasi-experimental study, with 16 patients, 12 men, with a mean age of 50.5±14.4 years, who participated in a supervised CPRP in a private clinic due to sequelae after COVID-19 infection. In both studies, patients underwent evaluation before and after the intervention period. Data collection from the anamnesis, included anthropometric and clinical data, and disease progression. Pulmonary function assessment included peak expiratory flow (PEF) and maximal inspiratory (MIP) and expiratory (MEP) pressures. Physical capacity was assessed through the six-minute walk test and handgrip dynamometry. Sessions were face-to-face and supervised by a cardiopulmonary rehabilitation specialist physiotherapist, conducted in-office or at home, lasting one hour, two or three times a week, including aerobic training, global muscle strengthening, and breathing exercises. Results: Study 1: There was a significant increase (112.5%) in the distance walked from baseline (240m) to post-training test (510m). Similarly, a significant increase in handgrip strength was observed in the right (from 21.6 to 31.8kgf) and left (from 18.7 to 26.3kgf) limbs. Finally, an increase in PEF (from 340 to 770L/min), MIP (from 60 to 85cmH2O), and MEP (from 80 to 95cmH2O) was observed. Study 2: An increase was documented in all studied variables: PEF (390.5±150.0 to 558.1±140.3L/min), MIP (89.4±37.5 to 123.1±40.2cmH2O), MEP (70.9±37.25 to 103.75±46.5cmH2O), 6MWD (320.2±97.6 to 568.2±75.9m), and handgrip strength of both right (19.3±8.3 to 38.2±10.6kgf) and left (19.8±9.1 to 33.3±9.9kgf) limbs, p<0.0001. A significant increase in pulmonary function was observed in both home and office-based training groups, with no statistical difference between them. Conclusions: Supervised cardiopulmonary rehabilitation program promotes significant improvement in physical capacity and pulmonary function in patients who presented sequelae due to severe COVID-19 infection. The improvement induced by physical training in pulmonary function is similar in home-based and office-based protocols.