Post-Critical Care COVID-19 Patient Benefits from a Robotic Patient-Guided Suspension System for Pulmonary Rehabilitation

摘要

The first case of coronavirus disease 2019 (COVID-19) in Singapore was diagnosed on 23 January 2020.As the number of COVID-19 cases increased in Singapore, 1 the healthcare system has had to manage more critical care patients and the sequelae of such prolonged, severe illness.In the rehabilitation of post-critical care COVID-19 patients, aspects of both pulmonary as well as neuromuscular rehabilitation exist.It is interesting that our patient who experienced frequent exertional desaturation benefitted from the use of a robotic patient-guided suspension system for mobilisation.Written informed consent was obtained from the patient.No approval was sought from Institutional Review Board as this was a case report.Our patient is a 61-year old Chinese male who was pre-morbidly well when he presented to his general practitioner with symptoms of fever and dry cough on 11 March 2020 (Day 2 of illness).He was treated with oral antibiotics but did not improve.He presented at our acute care hospital on Day 9 with a persistent cough and new-onset breathlessness.Chest radiograph revealed a left-sided pneumonia (Figure 1) and he was treated with meropenem, azithromycin, as well as oseltamivir.He deteriorated the next day and was intubated for acute respiratory distress syndrome (ARDS) complicated by type 1 respiratory failure.He tested positive for the SARS-CoV-2 virus by PCR testing, and was started on lopinavir/ritonavir (Kaletra) as well as interferon beta-1b.Due to side effects, treatment was switched to hydroxychloroquine.Six days of intravenous methylprednisolone for refractory wheeze was administered with clinical response.After mechanical ventilation for 15 days, he was extubated on Day 24.He was referred for inpatient rehabilitation on Day 30, after 2 negative COVID-19 swab results.He was oxygen-independent at rest but could only speak in phrases, and had exertional dyspnoea as well as resting tachycardia.Range of motion was full throughout and manual muscle testing via the