Efficacy and safety of HD-tDCS and respiratory rehabilitation for critically ill patients with COVID-19 The HD-RECOVERY randomized clinical trial.

BACKGROUND AND PURPOSE: Acute Respiratory Distress Syndrome (ADRS) due to coronavirus disease 2019 (COVID-19) has been associated with muscle fatigue, corticospinal pathways dysfunction, and mortality. High-Definition transcranial Direct Current Stimulation (HD-tDCS) may be used to attenuate clinical impairment in these patients. The HD-RECOVERY randomized clinical trial was conducted to evaluate the efficacy and safety of HD-tDCS with respiratory rehabilitation in patients with moderate to severe ARDS due to COVID-19. METHODS: Fifty-six critically ill patients were randomized 1:1 to active (n = 28) or sham (n = 28) HD-tDCS (twice a day, 30-min, 3-mA) plus respiratory rehabilitation for up to 10 days or until intensive care unit discharge. The primary outcome was ventilator-free days during the first 28 days, defined as the number of days free from mechanical ventilation. Furthermore, secondary outcomes such as delirium, organ failure, hospital length of stay and adverse effects were investigated. RESULTS: Active HD-tDCS induced more ventilator-free days compared to sham HD-tDCS. Patients in the active group vs in the sham group experienced lower organ dysfunction, delirium, and length of stay rates over time. In addition, positive clinical response was higher in the active vs sham group. There was no significant difference in the prespecified secondary outcomes at 5 days. Adverse events were similar between groups. CONCLUSIONS: Among patients with COVID-19 and moderate to severe ARDS, use of active HD-tDCS compared with sham HD-tDCS plus respiratory rehabilitation resulted in a statistically significant increase in the number of ventilator-free days over 28 days. HD-tDCS combined with concurrent rehabilitation therapy is a safe, feasible, potentially add-on intervention, and further trials should examine HD-tDCS efficacy in a larger sample of patients with COVID-19 and severe hypoxemia.

Alta hospitalar qualificada e orientações multidisciplinares aos pacientes idosos com COVID-19: revisão integrativa / Hospital discharge and multidisciplinary guidelines for elderly patients with COVID-19: integrative review

Resumo Objetivo buscar as evidências científicas disponíveis sobre orientações multidisciplinares ofertadas por profissionais da saúde aos pacientes idosos diagnosticados com a COVID-19 após a alta hospitalar. Método revisão integrativa da literatura realizada por meio das bases de dados/biblioteca virtual selecionadas para o desenvolvimento da pesquisa: Lilacs, MEDLINE/Pubmed, Scopus e CINAHL (EBSCO). Para a realização da busca foram utilizadas combinações com os seguintes Descritores em Ciência da Saúde (DeCS) e Medical Subject Headings (Mesh): Idoso (Aged); COVID-19; Cuidados Posteriores (Aftercare) e Alta do Paciente (Patient Discharge) combinados por meio dos operadores booleanos "AND" e "OR". Resultados foram identificadas referências entre janeiro de 2019 a janeiro de 2022 e recuperados quatro artigos para inclusão e análise desta pesquisa. As publicações selecionadas abordaram a temática da continuidade do cuidado com a perspectiva de intervenção em reabilitação à saúde e gerenciamento de sintomas e/ou supervisão da recuperação funcional da pessoa idosa, sendo tais orientações realizadas por equipe interprofissional. Conclusão evidenciou-se a escassez de publicações sobre a temática de orientações fornecidas pela equipe de assistência à saúde às pessoas idosas na perspectiva da alta hospitalar, bem como a importância e necessidade de futuras produções científicas em torno do impacto funcional decorrentes da COVID-19 nesta população, desde o momento da admissão hospitalar até o pós-alta no retorno para casa, subsidiada por ações estratégicas ou protocolos institucionais que viabilizem informações educativas para a preparação de uma alta hospitalar pautada no autocuidado, valorização do bem-estar e qualidade de vida das pessoas idosas.

Abstract Objective to search for available scientific evidence on multidisciplinary guidelines offered by health professionals to older patients diagnosed with COVID-19 after hospital discharge. Method an integrative literature review was carried out on the databases/virtual library selected: Lilacs, MEDLINE/Pubmed, Scopus and CINAHL (EBSCO). The search strategy involved use of combinations with the following Health Science Descriptors (DeCS) and Medical Subject Headings (Mesh): Elderly (Aged); Covid-19; Aftercare and Patient Discharge combined using Boolean operators "AND" and "OR". Results relevant articles published between January 2019 and January 2022 were identified, of which four were retrieved for inclusion and analysis. The selected studies addressed the theme of continuity of care with the perspective of intervention in health rehabilitation and symptom management and/or supervision of the functional recovery of older patients, with guidelines devised by an interprofessional team. Conclusion the study revealed the scarcity of publications on the topic of guidance provided by health care teams to older patients from the perspective of hospital discharge. The study also served to highlight the importance and need for future scientific output addressing the functional impact of COVID-19 on this population, from hospital admission to post-discharge at home, supported by strategic actions or institutional protocols that disseminate educational information preparing patients for hospital discharge and promoting self-care, well-being and quality of life of older people.