COVID-19’da akut ve kronik dönemde rehabilitasyonun yeri

COVID-19 pandemisi tüm dünyada sağlık sistemleri üzerinde büyük bir etki oluşturmuştur. Vakaların çoğu asemptomatik veya hafif olup, %15-20 kadarı şiddetli seyretmektedir. Şiddetli vakalarda ağır pnömoni ve akut solunum sıkıntısı sendromu yoğun bakım ünitesinde tedaviyi gerektirir. Yoğun bakımdan kurtulan hastalarda “Yoğun Bakım Sonrası Sendromu” olarak tanımlanan ve hastaların uzun süreli prognozunu belirleyen bazı fiziksel, bilişsel ve zihinsel bozukluklar görülmektedir. COVID-19 iyi bilinen pulmoner tutulumun yanısıra diğer birçok organ sistemlerini de etkilemektedir. Yoğun bakımla ilişkili komplikasyonlar, hastalığın pulmoner ve ekstrapulmoner tutulumları COVID-19 enfeksiyonu ile ilişkili sekel ve dizabiliteye sahip hasta sayısında artışa neden olacaktır. Bu nedenle COVID-19'dan sağ kurtulan hastalara yönelik etkili rehabilitasyon programlarının uygulanması gündeme gelmiştir. Pulmoner, nörolojik, kas-iskelet sistemi ve yoğun bakım ilişkili komplikasyonlar göz önüne alındığında, rehabilitasyon uzmanları COVID-19 hastalığı olan bireylerin iyileşme sürecinde önemli rol oynayacaktır. Bu derlemede COVID-19 enfeksiyonunun yoğun bakımla ilişkili komplikasyonları, pulmoner ve ekstrapulmoner tutulumlarından bahsedilecek ve mevcut erken kanıtlarla tedavisine ve genel rehabilitasyon yaklaşımlarına değinilecektir.

Anahtar Kelimeler:

Covid-19, Ekstrapulmoner, Rehabilitasyon, Yoğun bakım ilişkili kas güçsüzlüğü, Yoğun bakım sonrası sendromu

The role of rehabilitation in acute and chronic period of COVID-19

COVID-19 pandemic have enormous impact on healthcare systems around the world. The majority of cases are asymptomatic or mild, with a severe course in 15-20% of patients. In severe cases, treatment in the intensive care unit (ICU) is required for severe pneumonia and acute respiratory distress syndrome. A number of physical, cognitive and mental disorders defined as “Post-Intensive Care Syndrome” are seen in ICU survivors and determine the long-term prognosis of patients. COVID-19 affects other organ systems besides its well-known pulmonary involvement. ICU associated complications, pulmonary and extrapulmonary involvement of the disease will cause a growing proportion of patients with COVID-19 infection related sequelae and disability. Therefore, the implementation of effective rehabilitation programs for COVID-19 survivors has come to the fore. Considering the pulmonary, neurological, musculoskeletal and ICU related complications, rehabilitation professionals can play an important role in the recovery process of individuals with COVID-19 disease. In this review, intensive care associated complications of COVID-19 infection, pulmonary and extrapulmonary involvements will be discussed and treatment with available early evidence and general rehabilitation approaches will be mentioned.

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