Importance of Physical Therapy Interventions for Medically Complex Patient With Severe COVID-19: A Case Report

Abstract

Introduction and Purpose: The 2019 emergence of the coronavirus disease (COVID-19), and associated medical complications of pneumonia and acute respiratory distress syndrome, necessitated the development of safe and effective physical therapy (PT) interventions to treat this new patient population. The acuity of patients with COVID-19 resulted in intensive care unit (ICU)–acquired weakness and deconditioning. The purpose of this case study was to discuss the physical therapy contributions in treating a complex patient with COVID-19 who required venovenous extracorporeal membrane oxygenation (ECMO) support. Case Presentation: This case report discusses a patient who was 34 years old with morbid obesity, in her third trimester of pregnancy, who tested positive for SARS-CoV-2. The deteriorating respiratory status required the patient to have an emergent caesarean section, intubation, and ventilatory support. Methods: Worsening hypoxic respiratory failure and medical deterioration resulted in the initiation of ECMO. After 18 days, the patient was weaned off ECMO and medically cleared to initiate PT. Physical therapy interventions included positioning for airway clearance, bed mobility, transfer training, strengthening, mechanically assisted gait training, and patient education. Results: After 30 days, the patient was transferred back to the referring community hospital where she was subsequently weaned off oxygen support and discharged directly home. Conclusion: This case study outlines how initiating physical therapy interventions in the ICU in collaboration with other disciplines may have contributed to the functional recovery of a medically complex patient with COVID-19. Further research is recommended regarding early and collaborative interventions in the ICU for medically complex patients with COVID-19.