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Vibrotherapy in COVID-19. Respiratory physiotherapy with vibration in critically ill COVID-19 patients.

The scientific literature describes many techniques for manual respiratory physiotherapy that can be used for a variety of respiratory disorders. In case of the COVID-19 pandemic, the risk of exposure to the virus SARS-CoV-2 should be additionally minimized and the number of people caring for the patient should be reduced to an absolute minimum (to preserve the virus spread). Therefore, researchers from the Infanta Leonor University Hospital (Madrid, Spain) studied 10 critically ill and mechanically ventilated COVID-19 patients with pneumonia. The secretions remaining in the respiratory tract were mobilized using vibrations administered to the lower and posterior regions of the lungs in the prone position. The influence of vibrotherapy on the ratio of the oxygen partial pressure present in the arteries to the oxygen concentration from the inhaled breathing mixture delivered by the ventilator (paO2/FiO2) was analyzed. The higher the value of the paO2/FiO2, the greater the improvement in respiratory function.

  • The mean level of paO2/FiO2 in the supine position without vibration was 114.86;
  • in the prone position without vibration: 144.7;
  • in the prone position with vibrotherapy: 162.7.

Prepared on the basis of:

Respiratory physiotherapy with Vibration belts in the critical patient Covid-19 in the prone position. Sancho PT, Gandarias PA, González RS, Gurumeta AA. Rev Esp Anestesiol Reanim. 2020 Oct;67(8):481-482

Study population

Ten COVID-19 patients critically ill with pneumonia and mechanically ventilated were studied.

Test procedure

A vibrating physiotherapeutic belt was placed on the back and lower part of the chest in order to promote the mobilization of secretions from areas where they accumulate more robustly in supine patients. After 2 h spent in a prone position, three 15-min sessions of pulmonary vibrotherapy were performed, also in the prone position. Each 15-min session was separated from the next by 1 h of rest.

PaO2/FiO2 measurements were performed in 3 stages:

  • in the supine position without vibrations,
  • in the prone position without vibrations (after 2 h),
  • in the prone position with respiratory vibrotherapy (after 6 h, including 2 h of prone positioning without vibration + 4 h of intermittently administered vibrations in the prone position).

Use of vibration in the study

A standard vibrating belt was used (Inno-vagoods, Sauna effect model, 2019, Valencia, Spain), frequency 8 Hz, without the heating optional in this model. This frequency is similar to that used in the case of other devices generating therapeutic mechanical vibrations which have been used for many years to help get rid of secretions in the respiratory tract.

Results

The mean level of paO2/FiO2 in the supine position without vibration was 114.86 (17.25*), in the supine position without vibration: 144.73 (36.04), and in the prone position plus vibrotherapy: 162.66 (35.57).

{*The values in parentheses are a kind of a statistical deviation but the authors do not specify if it is standard deviation or standard error. Editorial note.}

Comment

The current situation related to the COVID-19 pandemic has significantly increased the need for mechanical ventilation in patients with acute respiratory distress syndrome. SARS-CoV-2 infection, causing a cytokine storm and an excessive immune response, damages the lung epithelium and alveoli by increasing their secretory functions, preventing proper gas exchange in undamaged alveoli. This increases the risk of severe atelectasis due to the formation of mucus plugs which completely occlude the bronchial lumen. {Atelectasis is common in mechanically ventilated patients. It is associated with the state of incomplete filling of the alveoli with respiratory gases, leading to lung collapse. Editorial note.}

Moving from supine to prone position can improve paO2/FiO2, improving pulmonary ventilation and perfusion, as well as mobilization of secretions. Additionally, by mobilizing the clearance of residual airway secretions by means of vibrating mechanical systems, the effect of prone positioning can be intensified. This prevents the formation of bronchiolar obstruction by mucous plugs and improves the paO2/FiO2.

{The scientific report published in the Spanish Journal of Anesthesiology and Resuscitation in the form of a letter which describes an original experiment by a group of Spanish scientists although with promising results has some limitations. The most important seems to be the study of the effect of vibrations in the patients, where there was also another examination – the influence of the prone positioning itself without physiotherapy – which was done directly before administering the analysed vibrations. It is therefore difficult to discuss the pure effect of the vibrations themselves. However, earlier studies including those cited by the authors, clearly indicate that in various pulmonary diseases vibrations facilitate the removal of residual secretions in the respiratory tract by means of palpation vibrations or devices generating therapeutic mechanical vibrations, i.e. vibrotherapy. That’s why the presented issue requires further research and brings hope for an improvement in physiotherapy of COVID-19, as well as post-covid rehabilitation, which may concern, as indicated by recent reports, a growing group of patients. Editorial note.}

More in:

Respiratory physiotherapy with Vibration belts in the critical patient Covid-19 in the prone position. Sancho PT, Gandarias PA, González RS, Gurumeta AA. Rev Esp Anestesiol Reanim. 2020 Oct;67(8):481-482

Author of the coverage:
Rafal Aleksander Guzik, PhD (med. sci)

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