Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup

BACKGROUND

With the Wuhan pandemic spread to India, more than lakhs of population were affected with COVID-19 with varying severities. Physiotherapists participated as frontline workers to contribute to management of patients in COVID-19 in reducing morbidity of these patients and aiding them to road to recovery. With infrastructure and patient characteristics different from the West and lack of adequate evidence to existing practices, there was a need to formulate a national consensus.

MATERIALS AND METHODS

Recommendations were formulated with a systematic literature search and feedback of physiotherapist experiences. Expert consensus was obtained using a modified Delphi method.

RESULTS

The intraclass coefficient of agreement between the experts was 0.994, significant at p < 0.001.

CONCLUSION

This document offers physiotherapy evidence-based consensus and recommendation to planning physiotherapy workforce, assessment, chest physiotherapy, early mobilization, preparation for discharge planning, and safety for patients and therapist in acutec are COVID 19 setup of India. The recommendations have been integrated in the algorithm and are intended to use by all physiotherapists and other stakeholders in management of patients with COVID-19 in acute care settings.

HOW TO CITE THIS ARTICLE

Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, et al. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020;24(10):905-913.

Comparison of Peripheral Arterial Blood Pressure in Individuals with and without Forward Head Posture

Introduction Cervical spine is closely approximated with neurovascular structures. Therefore, misalignment of cervical spine so commonly seen today may lead to altered blood pressure (BP). There could be a relationship between head neck posture as measured by craniovertebral angle and peripheral arterial BP.

Aim The aim of this study is to compare peripheral arterial BP in individuals with and without forward head posture (FHP).

Study Design This is a comparative, prospective, observational study in healthy population.

Subjects and Methods A total of 150 students were selected randomly and screened so that there were equal and desired number of subjects in the two groups (64 in each group) for this comparative, prospective, observational study. Three readings of BP were taken in sitting position on brachial artery at interval of 2 to 3 minutes. One standard image was taken in lateral view used for measuring craniovertebral angle with “MB ruler software.” Craniovertebral angle, systolic blood pressure (SBP), and diastolic blood pressure (DBP) of the two groups were compared.

Results The aim of the study was to compare peripheral arterial BP in individuals with and without FHP. The mean SBP and DBP of both the groups were within the normal range as was expected because the subjects were young students with no clinical symptoms. However, it was seen that the mean SBP was significantly higher in subjects with FHP than in subjects without FHP (p = 0.0009).

Conclusion Peripheral arterial BP in individuals with FHP is statistically significantly higher than in individuals without FHP.

Moderation of an online discussion on communication skills – A GSMC FAIMER experience

This article was migrated. The article was not marked as recommended. Discussion forums provide the ability for asynchronous discussion to occur over a period of time. The ability to learn asynchronously gives flexibility in learning and is one of the primary benefits of online learning. The combination of the asynchronous and interactive nature of the online learning environment encourages participants to engage in higher-order learning and reflection. To foster an optimal online learning community three components are important: cognitive presence, social presence and teacher presence in order to ensure that effective group discussions take place that can share meaning, identify areas of doubt, and attempt to reach a consensus and understanding of the subject being discussed. Moderating an online discussion is an art of its own and requires meticulous planning and execution strategies. Maintaining participant interest throughout the session can be quite challenging. This article is to share our experience in moderating a session as a part of the FAIMER programme in GSMC regional institution in Mumbai, India.

Clinical Profile of Patients Requiring Prolonged Mechanical Ventilation and their Outcome in a Tertiary Care Medical ICU

INTODUCTION

An increasing number of patients require mechanical ventilation and there has been a proportional increase in patients needing prolonged mechanical ventilation (ventilated for ≥ 21 days, for atleast 6 hours per day). It accounts for about 10% of all mechanically ventilated patients. Although these patients represent a smaller proportion of intensive care unit (ICU) patients, they consume substantial ICU resources. We studied etiology, metabolic and clinical profile, complications and outcome of these patients.

METHODS

This was a prospective observational study in the medical ICUs of a tertiary hospital over 18 months. All patients above 12 years of age requiring prolonged invasive mechanical ventilation were recruited. Detailed clinical and laboratory records were noted. Sequential Organ Failure Assessment (SOFA) score was calculated on admission.

RESULTS

Of a total 1150 patients who were admitted in ICU during study duration, 34.5% (n= 397) needed mechanical ventilation and 3.91% (n=45) required prolonged mechanical ventilation. Most common patient subsets were: acute inflammatory demyelinating polyneuropathy (AIDP) 28.50% (n=13), cerebro-vascular accident (CVA): 17.30% (n=8), tetanus 8.60% (n=4) and acute respiratory distress syndrome (ARDS) 6.50% (n=3). The mean age of patients was 32 years. Electrolyte imbalances observed were hypocalcaemia (84.44%), hypomagnesaemia (40.9%), hypokalemia (31.11%) and hypophosphatemia (23.8%). Ventilator-associated pneumonia (VAP) (53.33%) was the most frequent complication, followed by decubitus ulcers (40%) and deep vein thrombosis (8.89%). Mean duration of ICU stay was 57.02 days ± 44.73 days. Twenty six out of 45 patients (57.75%) were successfully weaned off ventilator support and discharged from the hospital. The SOFA score of patients who survived (mean 2.15) was lesser than that of patients who expired (mean 2.89) (p= 0.36, ns).

CONCLUSIONS

The incidence of prolonged mechanical ventilation in our study was 3.91% of total 1150 ICU admissions and 11.3% of the 397 patients requiring invasive mechanical ventilation. AIDP, CVA, tetanus and ARDS were the most common diagnoses. Survival in the study population was 57.75%. VAP was the most common complication. High incidence of hypocalcaemia, hypomagnesaemia, hypokalemia and hypophosphatemia was noted in patients requiring prolonged mechanical ventilation.