The ICU leaves sequelae of weakness in 50% of patients admitted for covid
The truth is that Dauci can manifest itself with myopathies –weakness in muscle groups– or through the development of polyneuropathy in the critical patient, a more complex ailment that affects nerve conduction. “The first usually occurs in people who spend less time sedated, while the second is associated with longer stays over time and is characterized by the damage it causes to the nerve conduction of motor and sensory axons. However, in some cases, both disorders can occur ”, details Sonia Esther Galván, physiotherapist at the UMI of the aforementioned capital center and professor associated with the Degree in Physiotherapy at the University of Las Palmas de Gran Canaria (ULPGC).
According to the professional, the work she does together with her partner Nieves Rodríguez at the Insular Hospital, where she already has 17 years of experience, is still very unknown by society. Their work implies great dedication to patients and, although the approach is similar in all groups of patients, regardless of the cause that led them to require admission to the critical care area, in people who occupy a bed due to the effects of the coronavirus can become more intense. “Our job is to achieve maximum autonomy for patients, that they are able to breathe without mechanical ventilation, improve their mobility and regain speech after tracheostomy. This can be a very long process and will depend, to a great extent, on prevention during sedation and the conditions in which they are when they wake up ”, says the expert.
Like all treatments, the ideal is to apply it early. In fact, there are already studies that support the great benefits of physiotherapy in patients who have been connected to mechanical ventilation for between 48 and 72 hours, since it allows them to be discharged in better conditions and also advance their discharge from the hospital. "This translates into great advantages for people, but also for the health system, which manages to reduce costs," adds Galván.
However, it should be noted that in order for physiotherapy to begin so early, it is necessary for patients to present certain respiratory and hemodynamic parameters, such as a positive pressure at the end of expiration (PEEP) lower than 12 or intracranial pressure below 20 millimeters of mercury, among others. “These parameters are those that are standardized and collected in different multicenter studies. Based on this, depending on the level of sedation and collaboration, our treatment plan can range from joint coaptations and joint hygiene to achieve muscle activation and avoid retractions, to sitting or standing them to achieve voluntary contraction assisted by the elderly. muscle groups ”, points out the physiotherapist of the UMI del Insular.
The truth is that Sonia Esther Galván has seen significant differences in the health status of patients suffering from SARS-CoV-2 infection during the three waves. And is that the improvement of the medical approach has made the prognosis of those affected is now more favorable, which has facilitated the work of physiotherapy. “Recently, we have also incorporated a stander and electrostimulation. All this, added to teamwork, has enriched the assistance to our patients ”, says the physiotherapist.