…to brush up on our respiratory intervention skills. These are my bread and butter. In the six years that I practiced in home healthcare, I learned to love these skills I never thought I’d need. And the more I grew to love them, the more I loved using them. But that means seeing the patients that are the most medically complex.
This brought me to heart and lung transplant care. That may seem scary for some people: providing aerobic exercise and respiratory interventions for patients who have just had their organs removed and replaced with someone else’s. But it is my passion. And that passion led me to get involved with the heart and lung transplant education team at my hospital system. I started providing the education courses for other PTs, OTs, and SLPs, so they could also provide these interventions and care for these patients with confident competence.
I can promise you, the patients being treated before or after transplant are just as scared as the ones being treated for COVID-19. No one knows what their outcomes will be. In lung transplant, we say “50% will live 5 years”. That may not sound like much, but many of these people are literally DAYS away from suffocating to death. It’s a chance they are willing to take.
With COVID-19, I imagine the feelings are the same. We don’t even know how long 50% of the hospitalized patients will live. We hope they return to the majority that recover, but not everyone will. Some will fall into that percentage that require extended hospitalization. The others will get the red tag.
I have taken a patient through YEARS of pulmonary pre-hab for a double lung transplant and many months of rehab after. She was on her way to visit family to say her final good-bye, trucking along her 10 L/min supply, when she got her phone call. The lungs were available. She knew what that meant, but she also knew she had to accept that reality quickly and get to the hospital. Thankfully, the family she was visiting lived nearby.
She had some rough road after her transplant, but it turned out to be successful. She had a beautiful two years of life after transplant. She returned to gardening, spending time outside, and welcomed a new grand-niece in to the world. So what kept her going?
SO. MUCH. PT.
Seriously, years of PT.
Obviously, you can’t do that in every setting. But, we spent our time strengthening her diaphragm using a Threshold IMT for progressive resistive exercise, diaphragmatic breathing activities with PNF-based manual inputs, practicing breathing with activity, PEP for airway clearance, active cycle of breathing, huffing, postural drainage, percussion, and even METs for rib mobility. She was in desperate need of cough efficiency planning because she had so little reserve.
I utilized auscultation and active pulse oximetry prior to and after interventions to demonstrate progress and instructed her in high-intensity interval training. Yes, even someone with advanced COPD, pulmonary hypertension, and an indwelling pulmonary catheter on 10 L/min of oxygen can do high-intensity interval training.
You can read more about this story here and see some beautiful pictures of respiratory interventions taking place. But more importantly, you can see the happiness that beams from her, even though she can hardly breathe.
If you’ve checked out the World Confederation of Physical Therapy’s Guidelines for PT Treatment of COVID-19 in Acute Care, you’ve seen these types of interventions listed. Patients who have COVID-19 need respiratory interventions from a skilled PT before they end up on a ventilator, during their ventilated time, and after they are removed from the ventilator. Active interventions should always be given priority over passive ones (aka EXERCISE!) but you do what you can. And don’t forget about contraindications for some interventions.
To perform these interventions properly for patients with COVID-19, the WCPT recommends that PTs who are already skilled and experienced in providing them be the ones to do so. However, that doesn’t mean you won’t see these patients outside of acute care. It’s time to brush up. It’s time to take back this part of our practice. We are the most skilled in providing physical interventions to improve cardiopulmonary function. If you haven’t done this stuff in a while, you can find online courses everywhere (or here!). We need more people providing these interventions because the demand is going to be high.
Image credit: Chris Clark, 2016
Do you think it’s time to brush up on your CV/P skills? Let me know what you feel like you need to most brushing up on in the comments!
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