Movement therapy in lung transplantation candidates assisted by a lightweight wearable robot.

The aim of this pilot-study was to investigate the safety, feasibility and tolerability of an assisted mobilization of patients with advanced pulmonary diseases, using a lightweight, exoskeleton-type robot (Myosuit, MyoSwiss AG, Zurich, Switzerland). Ten patients performed activities of daily life (ADL) both with and without the device. The mean age was 53.6 (±5.6) years; 70% were male. The assessment of outcome included the evaluation of vital signs, adverse events, rates of perceived exertion and dyspnea (PRE, PRD), the ability to perform ADL and the individual acceptability. Robotic-assisted mobilization was feasible in all patients. No adverse events occurred. RPE and RPD showed no significant difference with or without the Myosuit (mean difference in RPE -1.7, 95%-confidence interval (CI) -1.16, 4.49; p = 0.211; mean difference in RPD 0.00, 95%-CI -1.88, 1.88; p = 0.475). 80% of patients were interested to participate in a robotic-assisted training on a regular basis. A robotic exoskeleton-assisted mobilization is safe, feasible, well-tolerated and well-accepted. The results are highly encouraging to further pursue this highly innovative approach.

Qualidade de vida e aspectos funcionais de pacientes pós-Covid-19 submetidos à reabilitação pulmonar / Quality of life and functional aspects of post-Covid-19 patients submitted to pulmonary rehabilitation

INTRODUÇÃO: pacientes que tiveram Covid-19, independente do espectro clínico da doença, podem apresentar sintomas persistentes após a alta hospitalar por até 14 meses. Estes pacientes apresentam comprometimentos funcionais e de qualidade de vida sendo, portanto, indicada a reabilitação pulmonar. Este estudo avaliou os aspectos funcionais e a qualidade de vida de pacientes pós-Covid-19 atendidos em um programa de reabilitação pulmonar. MÉTODOS: trata-se de um estudo prospectivo do tipo coorte clínica. Os pacientes pós-Covid-19 que integraram um programa de reabilitação pulmonar por seis semanas consecutivas foram avaliados em relação às variáveis funcionalidade pelo Índice de Barthel e pela escala PCFS, e a qualidade de vida pelo SF-36 na admissão (T0) e após seis semanas de reabilitação (T1). RESULTADOS: Onze pacientes que participaram do estudo apresentaram melhora da funcionalidade tanto pelo Índice de Barthel (p<0,01) como pela escala PCFS (p<0,01) e, também, melhora da qualidade de vida nos domínios capacidade funcional (p< 0,01), limitação por aspectos físicos (p<0,05) e aspectos sociais (p<0,01) no T1 em relação ao T0. CONCLUSÃO: pacientes pós-Covid-19 apresentaram melhora da funcionalidade e da qualidade de vida após um programa de reabilitação pulmonar (AU),

INTRODUCTION: patients who have Covid-19, regardless of the clinical spectrum of the disease, may present, after hospital discharge, persistent symptoms for up to 14 months. These patients have functional and quality of life impairments and, therefore, pulmonary rehabilitation for six consecutive weeks is indicated. This article evaluated the functional aspects and quality of life of post-Covid-19 patients treated in a pulmonary rehabilitation program. METHODS: this is a prospective clinical cohort study. Post-Covid-19 patients who joined a pulmonary rehabilitation program were evaluated concerning the variables functionality by the Barthel Index and the PCFS scale, and quality of life by the SF-36 at admission (T0) and after six weeks of rehabilitation treatment (T1). RESULTS: Eleven patients who participated in the study showed improved functionality both by the Barthel Index (p<0.01) and the PCFS scale (p<0.01) and also improved quality of life in the functional capacity domains (p < 0.01), limitation due to physical aspects (p<0.05) and social aspects (p<0.01) at T1 compared to T0. CONCLUSION: post-Covid-19 patients showed improved functionality and quality of life after a pulmonary rehabilitation program (AU).

Impacto de la rehabilitación pulmonar en pacientes con enfermedad pulmonar restrictiva / Impact of pulmonary rehabilitation in patients with restrictive pulmonary disease

Introducción: Las enfermedades pulmonares restrictivas presentan alteraciones en la mecánica toracopulmonar, reducción de la capacidad funcional y de la función pulmonar. Se pueden encontrar las alteraciones intrínsecas y extrínsecas donde se ven alterados el intersticio, la expansibilidad torácica e incluso afecciones del parénquima pulmonar. La rehabilitación pulmonar podría beneficiar a pacientes con la condición restrictiva y mejorar su condición funcional. Objetivo Establecer el impacto de la rehabilitación pulmonar en pacientes con compromiso respiratorio restrictivo intrínseco y extrínseco en la disnea, capacidad funcional, ansiedad/depresión y calidad de vida relacionada con la salud. Métodos Estudio descriptivo longitudinal con 50 pacientes con enfermedad pulmonar restrictiva y quienes realizaron rehabilitación pulmonar en una clínica de la ciudad de Cali, Colombia. Los participantes vinculados al estudio fueron separados en dos grupos: el primero con enfermedad restrictiva intrapulmonar (ERI) y el segundo grupo con enfermedad restrictiva extrapulmonar (ERE). Resultados La edad media de los pacientes fue de 53,3años. Entre las enfermedades restrictivas intrapulmonares se presentaron: enfermedad intersticial pulmonar difusa (EPID), postcondición de neumonías o síndrome de dificultad respiratoria aguda (SDRA) y secuelas de tuberculosis pulmonar. Y entre las enfermedades respiratorias extrapulmonares: resección pulmonar, resección de lóbulo pulmonar y resección en cuña. Al finalizar la rehabilitación pulmonar el grupo ERI presentó mejorías estadísticamente significativas en la distancia recorrida, consumo de oxígeno estimado (VO2e), disnea, ansiedad y calidad de vida. El grupo ERE presentó incremento significativo en la distancia recorrida y VO2e (AU)

Introduction: Restrictive lung diseases present alterations in thoracic-pulmonary mechanics, reduced functional capacity and lung function. Intrinsic and extrinsic alterations can be found where the interstitium, thoracic expandability and even lung parenchymal conditions are altered. Pulmonary rehabilitation could benefit patients with the restrictive condition and improve their functional condition. Objective Establish the impact of pulmonary rehabilitation in patients with intrinsic and extrinsic restrictive respiratory compromise on dyspnea, functional capacity, anxiety/depression and health-related quality of life. Methods Longitudinal descriptive study with 50 patients with restrictive lung disease who performed pulmonary rehabilitation in a clinic in the city of Cali, Colombia. The participants linked to the study were separated into two groups, the first with intrapulmonary restrictive disease (IRD) and the second group with extrapulmonary restrictive disease (ERD). Results The mean age of the patients was 53.3years. Among the restrictive intrapulmonary diseases there were: diffuse interstitial lung disease (ILD), post-condition pneumonia and/or acute respiratory distress syndrome (ARDS) and sequelae of pulmonary tuberculosis. Extrapulmonary respiratory diseases: lung resection, pulmonary lobe resection, and wedge resection. At the end of pulmonary rehabilitation, the IRD group presented statistically significant improvements in distance covered, estimated oxygen consumption (VO2e), dyspnea, anxiety, and quality of life. The ERD group presented a significant increase in the distance traveled and VO2e. Conclusion Patients with restrictive lung disease improve the distance traveled, VO2e, dyspnea, anxiety and quality of life; patients with extrapulmonary respiratory disease show improvements in functional capacity (AU)

Current status and trends of pulmonary rehabilitation in South Korea: National level data analysis using Health Insurance Review and Assessment Service (HIRA) database from 2016 to 2018.

In South Korea, there are few studies to understand the current status of pulmonary rehabilitation in clinical practice and develop it. This study aimed to assess the current status and annual changes in the number and pattern of prescriptions for pulmonary rehabilitation before and after its insurance coverage. The trends of pulmonary rehabilitation before and after its insurance coverage commencement were evaluated using the data of 24,380 patients during the 3-year period from 2016 to 2018 that were archived by the National Health Information Database of the Health Insurance Review and Assessment Service in South Korea. The annual total number of patients who received pulmonary rehabilitation was stratified by the type of prescription, sex, age, type of insurance, medical institution, and region. In addition, the frequencies of pulmonary rehabilitation for various diagnoses were investigated using the major codes of the Korean Standard Classification of Disease. The patients who received pulmonary rehabilitation increased by approximately 2 times from 5936 in 2016 (before insurance coverage) to 10,474 in 2019. Before 2017, most patients underwent simple pulmonary rehabilitation coded as MM290. However, since the insurance coverage of rehabilitation exercise for pulmonary disease (MM440), the proportions of patients receiving them increased. Men underwent pulmonary rehabilitation more often than women, and >70% of the patients were aged >60 years. Most patients received pulmonary rehabilitation at tertiary hospitals in Seoul. In 2016, pulmonary rehabilitation was prescribed more frequently for cerebral infarction; after 2017, it was prescribed more frequently for lung cancer. This study summarized the current status and trends of pulmonary rehabilitation in South Korea before and after National Health Insurance Service coverage, which commenced on January 1, 2017. A significant increase in the number of pulmonary rehabilitations was confirmed after the insurance coverage.

[Individualized rehabilitation strategies for patients with critical pulmonary diseases].

Individualized rehabilitation for patients with critical pulmonary diseases is a comprehensive intervention system that emphasizes individualized intervention with multidisciplinary specialties with different medical background support. On the basis of ensuring patients' safety, and evaluation of the right time for intervention, combined ABCDEF bundle strategies are used to implement individualized rehabilitation programs. In the process of rehabilitation treatment, we perform dynamic evaluation of the benefit and risk of individualized rehabilitation for patients suffering critical pulmonary diseases, and formulate adverse reaction prevention and control plans, and therefore to effectively improve the physical and psychological functions of patients, reducing complication and post- ICU syndrome, and promoting recovery.

Characteristics of pulmonary rehabilitation programmes in New Zealand: a survey of practice prior to and during COVID-19.

AIM: The primary aim of this survey was to develop an understanding of current pulmonary rehabilitation practices in New Zealand. The onset of a COVID-19 lockdown in New Zealand in March 2020, shortly after completion of the initial survey, enabled a follow-up survey to determine how services had adapted in response to the global pandemic. METHODS: A cross-sectional observational design using two sequential purpose designed online surveys administered before (Survey 1) and after COVID-19 lockdowns (Survey 2) in New Zealand. RESULTS: Survey 1 was completed by 36 PR services across New Zealand and showed homogeneity in the content and structure of services provided. PR was primarily funded by district health boards, run by a multi-disciplinary team of health professionals and included participants with a range of chronic respiratory conditions. All programmes completed pre- and post-PR assessments, were a minimum of eight weeks in duration and included exercise and education. Survey 2 showed that, during level 4 and level 3 COVID-19 restrictions, 11 (40.7%) of services paused PR programmes, with 16 (59%) adapting the service to provide home-based rehabilitation via telephone or teleconference facilities. CONCLUSION: PR programmes in New Zealand report following Australian and New Zealand PR best practice guidelines and are homogenous in content and structure, but COVID-19 restrictions highlighted the need for services to provide more diverse options for service delivery. Future service development should focus on providing a range of delivery options allowing increased access to PR, tailoring therapy to meet individual needs and ensuring services are engaging for all participants to optimise participation.

Telemonitoring of daily activities compared to the six-minute walk test further completes the puzzle of oximetry-guided interventions.

Pulmonary rehabilitation is based on a thorough patient assessment, including peripheral oxygen saturation (SpO2) and heart rate (HR) at rest and on exertion. To understand whether exercise-field tests identify patients who desaturate (SpO2 < 90%) during physical activities, this study compared the six-minute walk test (6MWT) and daily-life telemonitoring. Cross-sectional study including 100 patients referred for pulmonary rehabilitation. The 6MWT was performed in hospital with continuous assessment of SpO2, HR, walked distance and calculated metabolic equivalent of tasks (METs). Patients were also evaluated in real-life by SMARTREAB telemonitoring, a combined oximetry-accelerometery with remote continuous assessment of SpO2, HR and METs. SMARTREAB telemonitoring identified 24% more desaturators compared with the 6MWT. Moreover, there were significant mean differences between 6MWT and SMARTREAB in lowest SpO2 of 7.2 ± 8.4% (P < 0.0005), in peak HR of - 9.3 ± 15.5% (P < 0.0005) and also in activity intensity of - 0.3 ± 0.8 METs (P < 0.0005). The 6MWT underestimates the proportion of patients with exercise-induced oxygen desaturation compared to real-life telemonitoring. These results help defining oximetry-guided interventions, such as telemedicine algorithms, oxygen therapy titration and regular physical activity assessment in pulmonary rehabilitation.

The effect of pulmonary rehabilitation on physical performance and health related quality of life in patients with chronic lung disease.

Pulmonary rehabilitation (PR) is a multidisciplinary approach that improves exercise capacity and health-related quality of life in patients with chronic lung disease. We retrospectively reviewed the medical records of the patients with chronic lung disease who participated in the PR program at University Medical Center in Lubbock, Texas, between 2014 and 2019. Clinical information, 6-min walk test (6 MW T) results, the number of emergency department (ED) visits and hospitalizations, and psychosocial questionnaires (CAT score, PHQ9 and mMRC dyspnea score) were recorded before and after the completion of the program. Multiple variable linear regression and logistic regression were used to analyze the relationships between patient characteristics and changes in the 6-min walk distance and the achievement of a minimal clinically important differences (MCID) in the 6-min walk distance, the CAT score, the PHQ-9, and the mMRC. 279 patients enrolled in pulmonary rehabilitation; 144 patients (52%) completed the program. After completion of the program, 84 patients increased their 6 MW T distance to exceed the MCID with a mean increase of 178 feet, and the number of ED visits and hospitalizations decreased from 0.80 ± 1.11 to 0.55 ± 0.87 (p < 0.05) in the six months before and after rehabilitation. There were statistically significant improvements in all three psychosocial scores. Factors associated with non-completion included younger age, female gender, and shorter baseline 6 MW T distances. The MCID helps evaluate patient outcomes following pulmonary rehabilitation and provide more definite assessment of benefits. The high dropout rate indicates that programs must continuously monitor patient participation and interest.

Pulmonary rehabilitation for COVID-19: A living systematic review protocol. / Rehabilitación pulmonar en COVID-19: protocolo de una revisión sistemática viva.

OBJECTIVE: This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. DESIGN: This is the protocol of a living systematic review. DATA SOURCES: We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. ELIGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS: We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. ETHICS AND DISSEMINATION: No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

OBJETIVO: Proporcionar un resumen oportuno, riguroso y continuamente actualizado de la evidencia disponible sobre el papel de la rehabilitación pulmonar en el tratamiento de los pacientes con COVID-19. DISEÑO: Es el protocolo de una revisión sistemática viva. FUENTE DE DATOS: Realizaremos búsquedas en la plataforma L·OVE (Living OVerview of Evidence) para COVID-19, un sistema que mapea los componentes de las preguntas de investigación (PICO) en un repositorio mantenido a través de búsquedas regulares en bases de datos electrónicas, servidores de pre-impresión, registros de ensayos y otros recursos relevantes para COVID-19. No se aplicarán restricciones de fecha ni de idioma. CRITERIOS DE ELEGIBILIDAD PARA LA SELECCIÓN DE ESTUDIOS Y MÉTODOS: Se adaptó un protocolo común ya publicado para revisiones sistemáticas paralelas múltiples a las especificidades de la pregunta. Se incluirán ensayos aleatorios que evalúen el efecto de la rehabilitación pulmonar como monoterapia o en combinación con otras intervenciones frente a un tratamiento simulado o ningún tratamiento en pacientes con COVID-19. Dos revisores examinarán de forma independiente cada estudio para determinar su elegibilidad, extraerán los datos y evaluarán el riesgo de sesgo. Se agruparán los resultados mediante un metaanálisis y se aplicará el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE) para evaluar la certeza de las pruebas para cada resultado. ÉTICA Y DIFUSIÓN: No se considera necesaria la aprobación ética. Los resultados de esta revisión se difundirán ampliamente a través de publicaciones revisadas por pares, redes sociales y medios de comunicación tradicionales.

Pulmonary rehabilitation for COVID-19: a living systematic review protocol

Objective This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. Design This is the protocol of a living systematic review. Data sources We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. Ethics and dissemination No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

Perspective of Pulmonary Rehabilitation Centers in Latin America.

Pulmonary rehabilitation (PR) is a mandatory component of a comprehensive treatment of patients with chronic respiratory disease. However, there is no officially published data about PR Centers in Latin America.The objetive is to identify Latin American Pulmonary Rehabilitation Centers and evaluate their characteristics and organizational aspects.A cross-sectional study with the Pulmonary Rehabilitation Centers indicated by the Latin American Respiratory and Physiotherapy Societies and by our own personal survey among physicians and physiotherapists. An eletronic transmission questionnaire with 20 questions was sent to the Coordinator of each one of the Centers.217 Pulmonary Rehabilitation Centers were found throughout Latin America and a total of 160 (73.7%) Centers answered the questionnaire. Of these, 65.8% had private administration; 68.8% had an associated program for patients with heart disease; programs lasted an average of 24 sessions; the rehabilitation team consisted mainly of physiotherapists, physicians and dietitians; 90.6% of the centers evaluated the patients with different questionnaires; 91.9% used treadmill and 90.6% bicycle for exercises of lower limbs and 80.1% proprioceptive neuromuscular facilitation technique with weights to train the upper limbs of their patients; 55.6% had an educational program and 36.9% presented a home-based program.There has been a great increase in the number of Latin American Pulmonary Rehabilitation Centers, presenting diversity in organizational aspects.

Digital Health Technology and Telemedicine-Based Hospital and Home Programs in Pulmonary Medicine During the COVID-19 Pandemic.

BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic has caused a significant strain on medical resources throughout the world. A major shift to telemedicine and mobile health technologies has now taken on an immediate urgency. Newly developed devices designed for home use have facilitated remote monitoring of various physiologic parameters relevant to pulmonary diseases. These devices have also enabled home-based pulmonary rehabilitation programs. In addition, telemedicine and home care services have been leveraged to rapidly develop acute care hospital-at-home programs for the treatment of mild-to-moderate COVID-19 illness. AREAS OF UNCERTAINTY: The benefit of remote monitoring technologies on patient outcomes has not been established in robust trials. Furthermore, the use of these devices, which can increase the burden of care, has not been integrated into current clinical workflows and electronic medical records. Finally, reimbursement for these telemedicine and remote monitoring services is variable. DATA SOURCES: Literature review. THERAPEUTIC ADVANCES: Advances in digital technology have improved remote monitoring of physiologic parameters relevant to pulmonary medicine. In addition, telemedicine services for the provision of pulmonary rehabilitation and novel hospital-at-home programs have been developed. These new home-based programs have been adapted for COVID-19 and may also be relevant for the management of acute and chronic pulmonary diseases after the pandemic. CONCLUSION: Digital remote monitoring of physiologic parameters relevant to pulmonary medicine and novel hospital-at-home programs are feasible and may improve care for patients with acute and chronic respiratory-related disorders.

Effects of inspiratory muscle training on resting breathing pattern in patients with advanced lung disease.

AIM: The aim of this study was to evaluate the effects of interval high intensity inspiratory muscle training (IMT) on resting breathing pattern in patients with advanced lung disease. METHODS: IMT was performed daily and training load set at 50 % of the maximal inspiratory pressure. Participants were evaluated at pre-IMT, post 8 weeks of IMT and follow-up (3 months after the end of IMT). Breathing pattern (volume and time variables as well as percentages of contribution to tidal volume) was evaluated by Optoelectronic Plethysmography at rest. Friedman test was used to verify the differences between the three time-points (p < 0.05). RESULTS: Nineteen patients (54 ± 16 years old; 5 males) were evaluated at pre-IMT and post-IMT and fourteen were assessed at follow-up. There was no significant difference (p > 0.05) in any comparison for all evaluated breathing pattern variables at the three time-points. CONCLUSION: Resting breathing pattern was not significantly changed after 8 weeks of IMT in patients with advanced lung disease.

Efecto de la rehabilitación pulmonar sobre la función respiratoria y la capacidad de ejercicio en personas con enfermedad pulmonar crónica / Effect of pulmonary rehabilitation on respiratory function and exercise capacity in people with chronic lung disease

Resumen Justificación y objetivo: Los problemas pulmonares crónicos son una de las principales causas de discapacidad en las personas adultas mayores. Estas enfermedades afectan negativamente la calidad de vida y la capacidad funcional de las personas, debido a la interacción entre el proceso normal de envejecimiento y la fisiopatología. Sin embargo, los programas de rehabilitación pulmonar parecen ser una opción terapéutica efectiva para tratar esta problemática. A pesar de esto, en Costa Rica no es una posibilidad disponible en todos los centros de salud y existe limitada evidencia sobre su efectividad. Este estudio intenta identificar el efecto de un programa de rehabilitación pulmonar sobre la función respiratoria y la capacidad de ejercicio de personas adultas mayores con enfermedad pulmonar crónica. Métodos: Se realizó un análisis retrospectivo del efecto de un programa de ejercicio físico sobre la función respiratoria y la capacidad de ejercicio en 53 personas adultas con enfermedad pulmonar crónica. Los datos fueron recolectados en el Hospital Nacional de Geriatría y Gerontología-Caja Costarricense de Seguro Social, de personas que participaron en el programa entre enero 2012 y diciembre 2017. Resultados: Hubo mejoras estadísticamente significativas en la función respiratoria (p<0,001) y la capacidad de ejercicio (p<0,001) de los sujetos, luego de participar en el programa. Conclusión: El programa de rehabilitación pulmonar mejoró la función respiratoria y la capacidad de ejercicio.

Abstract Background and aim: Chronic lung problems are one of the main causes of disability in older adults. These diseases negatively affect the quality of life and functional capacity of these people, due to the interaction between the normal aging process and the pathophysiology. However, pulmonary reconditioning programs seem to be an effective therapeutic alternative to treat this problem. Despite this, in Costa Rica it is not an option available in all health centers and there is limited evidence on its effectiveness. Therefore, this study attempts to identify the effect of pulmonary rehabilitation on the respiratory function and aerobic capacity of exercise among older adults with chronic obstructive pulmonary disease. Methods: For which a retrospective analysis of the effect of a physical exercise program on ventilatory function and aerobic capacity of exercise in 53 adults with chronic lung disease wasperformed. Data were collected at the National Hospital of Geriatrics and Gerontology - Caja Costarricense de Seguro Social, of people who participated in the program between January 2012 and December 2017. Results: It was determined that there were statistically significant improvements in respiratory function (p <0.001) and capacity of exercise (p <0.001) of the subjects after participating in the program. Conclusion: The pulmonary rehabilitation program improved respiratory function and exercise capacity.

Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings.

Pulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high-resource settings. In low- and middle-income countries, PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; pre-publication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED, and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality of life (HRQoL), breathlessness, included components, and mode of delivery. We used Cochrane risk of bias (RoB) to assess study quality and synthesised data narratively. From 8912 hits, we included 13 studies: 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, and breathing exercises. Low cost services, adapted to the setting, used limited equipment and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low-resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.

[Management strategy of lung protection in patients with intra-abdominal infection].

Lung protection is important in the treatment of patients with intra-abdominal infection (IAI). This article focuses on the management strategy of lung protection in IAI patients. In the implementation of IAI individual respiratory protection, good humidification and chest physical therapy, nutritional support, strict balloon management, keeping a semi-supine position, and reducing the duration and depth of analgesia and sedation are helpful to maintain effective coughing capacity and prevent silent aspiration. It is also necessary to prevent ventilator-associated lung injury in mechanical ventilation, and implement strategies of small tidal volume, limited platform pressure, diaphragmatic protection and right heart protection ventilation in acute respiratory distress syndrome (ARDS). Respiratory mechanical indicators, including airway resistance, respiratory compliance, maximum inspiratory pressure (MIP), and airway closure pressure (P0.1) can be used in IAI patients receiving mechanical ventilation for individualized assessment and monitoring of respiratory functional status. Patients with IAI who have not been treated with mechanical ventilation can use simplified bedside lung function indicators, including forced vital capacity of inhalation and exhalation, maximum inspiratory pressure and exhalation pressure, as well as volume and rate of 1s. In pulmonary rehabilitation, the protection technique of the seven-word principle of humidification, turning, patting, coughing, expansion, blowing and mobilization are implemented.

Reabilitação pós COVID-19 / Post COVID-19 rehabilitation

A partir do conceito de "reabilitação" sintetiza evidências relevantes disponíveis sobre a reabilitação de pacientes internados e/ou recuperados da infecção pelo SARS-CoV-2 (COVID-19). Citam as principais recomendações para pacientes com Covid-10 e os Programas de Reabilitação direcionados para reabilitação na síndrome pós COVID-19 no Brasil, neste contexto, afirmam que a maioria dos programas de reabilitação é composta por equipes multiprofissionais envolvendo diferentes categorias: médico, enfermeiro, fisioterapeuta, terapeuta ocupacional, psicólogo, educador físico e fonoaudiólogo. Discorre sobre a atenção primária e apontam mudanças na forma de atendimento no cenário da pandemia da covid-19, e lista os cuidados, recomendações pertinentes

From the concept of "rehabilitation" it synthesizes relevant evidence available on the rehabilitation of hospitalized and/or recovered patients from SARS-CoV-2 (COVID-19) infection. They cite the main recommendations for patients with Covid-10 and the Rehabilitation Programs aimed at rehabilitation in post COVID-19 syndrome in Brazil, in this context, they state that most rehabilitation programs are composed of multidisciplinary teams involving different categories: doctor, nurse , physiotherapist, occupational therapist, psychologist, physical educator and speech therapist. It discusses primary care and points to changes in the form of care in the covid-19 pandemic scenario, and lists the precautions, pertinent recommendations