COVID-19 in the acute setting – A position paper by the Italian Association of Respiratory Physiotherapists

Author(s): Giuseppe Gaudiello, ERS Member (Italy)

DocumentRespiratory physiotherapy in patients with CoViD-19 infection in the acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR)

Authors: Marta Lazzeri, Andrea Lanza, Raffaella Bellini, Angela Bellofiore, Simone Cecchetto, Alessia Colombo, Francesco D’Abrosca, Cesare Del Monaco, Giuseppe Gaudiello, Mara Paneroni, Emilia Privitera, Mariangela Retucci, Veronica Rossi, Martina Santambrogio, Maurizio Sommariva, Pamela Frigerio

Description: In February 2020, Italy and especially its northern regions was hit by an epidemic of the SARS-Cov-2 coronavirus, which spread from China between December 2019 and January 2020. In these regions, entire hospital buildings and wards have been converted into semi-intensive and intensive care units, and trained dedicated COVID-19 teams consisting of physicians (intensivists or pneumologists or other trained specialists), infectiologists and nurses have been recruited to work on and on without rest.

Physiotherapists, mainly respiratory physiotherapists, are among the healthcare professionals involved in the management and care of these patient populations, and play a key role in non-invasive support management, postural changes, mobilisation and during weaning from invasive mechanical ventilator support. The main goal of such treatments is to reduce side-effects in these patient populations while ensuring maximum protection for healthcare professionals.

Topics covered in this document include:

  • Italian physiotherapists experiences with SARS-Cov-2 patients
  • Best practice recommendations for spontaneously breathing patients or those with non-invasive ventilatory support
  • Recommendations for patients on invasive mechanical ventilation
  • Procedures that should not be applied in the acute phase
  • Measures for prevention and control of infections

Comments: This statement summarises best-practice recommendations for COVID-19 patients in acute setting, from the perspectives of the Italian Association of Respiratory Physiotherapists and Italian Association of Physiotherapists. Based on the ongoing status of the outbreak, the document has not been prepared using the typical methods for practice guidelines according to classic ERS methodology.

Patients affected by COVID-19 who need to be hospitalised present viral pneumonia, often complicated by an acute respiratory failure, which may eventually evolve to acute respiratory distress syndrome. To face this emergency, entire hospital wards need to be transformed into intensive care and high-dependency units in order to host patients requiring ventilatory support, and properly trained staff are required to efficiently manage such units.

Further recommendations:

Covid-19 blog
General respiratory patient care
Respiratory infections
Respiratory intensive care