A case of early rehabilitation of a patient with severe pandemic influenza A / H1N1 complicated by pneumonia and acute respiratory distress syndrome

Abstract

A case of early physical rehabilitation of a female patient with severe pandemic influenza А / H1N1 complicated by pneumonia and acute respiratory distress syndrome (ARDS) is described in the article. Lymphatic drainage of the lower extremities and the lungs and the chest vibration were used in the patient under mechanical ventilation after achieving clinical stability at the day 2 of staying in a ICU. Postural drainage in combination with the chest and the upper extremities vibration in the Sims’ position were used at the day 3. Active physical exercise with a stretch band and cognitive therapy (reading books, listening to music, and occupational therapy) were started at the day 4. At the day 5, the intubated patient took few steps near the bed assisted by a physical therapist and a physician. After extubation, the patient walked every day in the ward and along the hospital corridor under a control of HR, BP, and SaO2. She used breathing techniques (diaphragmatic breathing, resistive breathing) and physical training. The rehabilitation sessions continued up to the hospital discharge. Conclusion. Early physical and occupational therapy was found to reduce a risk of polyneuropathy predictive for unfavorable outcome and can improve the airway clearance with reduction of nosocomial infection risk.