Diagnosis and Treatment Plan For the COVID-19 Rehabilitation Unit
Due to the pandemic’s particularity, CRU has not been launched in other hospitals and other countries. Moreover, due to the lack of a clear understanding of the changes in COVID-19 and the characteristics of dysfunction, it is not yet possible to determine the most reasonable rehabilitation medical plan. We also tried and explored CRU’s work and management model based on the stroke unit management model. At the same time, we actively drew on various expert consensus and guidance on rehabilitation during the SARS and COVID-19 pandemic to carry out related work, including the Rehabilitation Plan for Discharged Patients from COVID-19 (Trial) issued by the General Office of the NHC, the Expert Consensus on Rehabilitation Diagnosis and Treatment During the Pandemic of Respiratory Infectious Diseases Rased on CO VID-19 issued by the Chinese Society of Rehabilitation Medicine, and Guiding Opinions on Respiratory Rehabilitation for COVID-19 issued by the Chinese Association of Rehabilitation Medicine in conjunction with the Respiratory Rehabilitation
Committee of the Chinese Association of Rehabilitation Medicine and the Cardiopulmonary Rehabilitation Group of the Chinese Physical Medicine and Rehabilitation Branch.
CRU is an integrated management system and process for diagnosis, evaluation, observation, treatment, and rehabilitation of COVID-19 patients. Patients can receive targeted and individualized rehabilitation treatment plans, including medications quickly. These programs can promote the absorption of lung inflammation in patients with COVID-19, reduce clinical symptoms related to pneumonia (cough, palpitation, chest tightness, fatigue, etc.), improve patients’ respiratory function, improve heart and lung functions, and increase respiratory muscle strength. Moreover, the implementation of these programs can prevent various complications (including deep vein thrombosis of the lower extremities, pressure sores, and deterioration of skeletal muscle function, etc.) and enhance exercise endurance and physical strength. It can also relieve anxiety and depression, improve patients’ activities of daily living, help patients gradually return to their families and society, and reduce the after-effects of COVID-19. It is necessary to improve the long-term quality of life of patients as a work goal and carry out targeted medical treatment.
COVID-19 is caused by SARS-CoV-2 acting on the ACE2 receptor and enters cells through receptor-mediated endocytosis. It mainly infects ciliated bronchial epithelial cells and types II alveolar cells, causing systemic diseases with lung damage. Acute lung inflammation damages lung epithelial cells and pulmonary capillary endothelial cells, causes pulmonary interstitial and alveolar edema, affects oxygen diffusion, and causes alveolar gas exchange disorders. At the same time, the alveolar surface-active substances decrease, the alveoli collapse, and the number of alveoli participating in the gas exchange on the alveolar surface decreases. The ventilation/blood flow ratio is imbalanced, and the lung ventilation function decreases. For severe and critically severe patients, pulmonary fibrosis may also occur in the later stage, and restrictive ventilation dysfunction may occur. Therefore, COVID-19 patients have respiratory symptoms such as dyspnea, chest tightness, and wheezing. Through the results of lung function testing, it is possible to identify whether the patient is ventilator dysfunction or diffuse dysfunction, and the type of ventilatory dysfunction (obstructive, restrictive, mixed).
Limb weakness, wheezing, and fatigue during activity are common clinical symptoms of COVID-19, which can be the first symptoms of the onset and last for a long time. Even after returning to the community and at home, it is still the biggest problem that affects patients. Therefore, exercise training is one of the important contents of pulmonary rehabilitation. The exercise test can assess the patient’s cardiopulmonary function and exercise capacity (muscle strength, exercise endurance, overall exercise level, etc.), and understand the patient’s finger oxygen saturation and heart rate during exercise. It can develop safe, moderate, and individualized exercise prescriptions for patients. Studies have found that cardiomyocytes, renal proximal tubule epithelial cells, bladder epithelial cells, esophagus, ileum, etc., all have high expression of ACE2. Therefore, COVID-19 not only infects the respiratory system but also affects the circulation, urinary, and digestive systems. Critically severe patients will experience damage to multiple organs, including the heart. Heart damage may be related to hypoxemia, respiratory failure, inflammation, and viral infection that directly damage the myocardium. Abnormal blood biochemical indicators are often found in severe and critically severe patients, such as serum myocardial necrosis marker-cardiac troponin I (c'/h/), creatine kinase isoenzyme (Ck-MB), lactate dehydrogenase (LDH), abnormal levels of liver enzymes and kidney function. Clinical practice has found that COVID-19 patients are often accompanied by symptoms such as palpitation, hyperhidrosis, anorexia, and diarrhea. Therefore, these physical dysfunctions also require long-term attention and comprehensive intervention.
COVID-19 patients often have fear, anxiety, and even depression due to their uncertainty about the disease. There are also some patients who have Post-Traumatic Stress Disorder (PTDS) brought about by a major pandemic, which all lead to psychological disorders. It is often clinically manifested as asking about one’s own condition repeatedly, or being indifferent to the outside world, or full of fear and worry about the disease. In severe cases, insomnia and even suicidal tendencies occur. Therefore, active psychological intervention and guidance can help patients overcome fear and anxiety and build confidence in overcoming the disease.
Barriers to Social Participation
The basic point of recovery for COVID-19 patients is to gain enough independence, avoid dependence, and eventually return to families and society. The majority of COVID-19 patients are elderly people. Many people have multiple underlying diseases such as hypertension, diabetes, and hyperlipidemia, which aggravate the dysfunction of discharged patients. Therefore, activities of daily living (ADL) training has a certain effect and significance.