Related Experiment Video
Updated: Oct 5, 2025
Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Safety and feasibility of physiotherapy in ICU-admitted severe COVID-19 patients: an observational study
Veronica Rossi1, Martina Santambrogio2, Cesare Del Monaco3
1Health Professions Department Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan. veronica.rossi@policlinico.mi.it.
Insights
Early physiotherapy is safe and feasible for severe COVID-19 patients in intensive care units (ICUs). This intervention, though delayed, aids in recovery and mobilization for critically ill individuals.
Area of Science:
- Critical Care Medicine
- Rehabilitation Medicine
- Infectious Diseases
Background:
- Severe COVID-19 often leads to prolonged intensive care unit (ICU) stays, resulting in significant deconditioning.
- The role and safety of early physiotherapy in managing severe coronavirus disease 2019 (COVID-19) patients remain unclear.
- Understanding the specific interventions and outcomes is crucial for optimizing patient recovery.
Purpose of the Study:
- To describe the physiotherapy interventions provided to severe COVID-19 patients requiring invasive mechanical ventilation.
- To evaluate the safety and feasibility of early physiotherapy in this population.
- To analyze the timing of interventions and patient mobilization milestones.
Main Methods:
- A consecutive series of adult patients with confirmed SARS-CoV-2 infection admitted to the ICU and requiring mechanical ventilation for over 24 hours were enrolled.
- Physiotherapy sessions were monitored for adverse events.
- Data collected included the type and timing of physiotherapy, time to first mobilization, standing, and walking, and functional assessments at hospital discharge.
Main Results:
- Eighty-four severe COVID-19 subjects were included, with few minor adverse events reported, indicating safety.
- Active mobilization was prioritized over passive, supporting independence in daily activities.
- The median time from intubation to first physiotherapy was 13 days, and to walking was 27 days.
- Tracheostomy was associated with delayed mobilization (sit out of bed, ambulation) but not with differences in 6-minute walk test (6MWT) or 1-meter sit-to-stand test (1m-STST) performance.
Conclusions:
- Early physiotherapy is a feasible and safe intervention for severe COVID-19 patients in the ICU, benefiting both patients and healthcare workers.
- While safe, physiotherapy delivery was observed to be delayed compared to non-COVID-19 critically ill patients.
- Further research may optimize the timing and delivery of physiotherapy to improve outcomes for these patients.
Abstract:
Early physiotherapy could play an important role in the management of severe COVID-19 subjects with consequences of prolonged ICU stay, although its effectiveness is still unclear. Aim of this study is to describe physiotherapy performed in severe COVID-19 patients and to evaluate its safety and feasibility. Consecutive adults with confirmed SARS-CoV-2 infection, admitted to the ICU, needing invasive mechanical ventilation for >24 hours and receiving early physiotherapy, have been enrolled. Adverse events occurred during physiotherapy sessions and timing and type of physiotherapy delivered were analysed, to identify the interventions most frequently performed and to determine the time taken to first mobilize, stand and walk. Functional and clinical assessment of patients was also performed at hospital discharge. Eighty-four severe COVID-19 subjects were enrolled. Few minor adverse events were recorded. Active mobilization was promoted over passive mobilization and independence in daily life activities was supported. Time interval from patients' intubation to the first physiotherapy treatment was 13 days and to walking was 27 days. Forty-eight (57.1%) subjects returned at home, whereas 29 (34.5%) were discharged to in-patient rehabilitation. Patients with tracheostomy experienced a delay in time from ICU admission until sit out of bed and ambulation, if compared with subjects without tracheostomy, although no differences were found in 6MWT and 1m-STST performances. This study reporting early physiotherapy during pandemic suggests that this intervention is feasible and safe for severe COVID-19 subjects, as well as healthcare workers, although delayed compared to other critically ill patients.
More Related Videos
07:16An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
10:38Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
Related Concept Videos
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:24Chest Physiotherapy
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing...
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...