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Breathing against resistance (PEP THERAPY Positive expiratory pressure)-Recommendations for physiotherapy interventions in patients with respiratory system infection with the virus SARS-CoV-2

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https://www.cff.org/managing-cf/positive-expiratory-pressure
Institution
Croatian Society for Cardiorespiratory Physiotherapy; Croatian thoracic society, Special hospital for pulmonary diseases, Zagreb; Clinic for pulmonary diseases Jordanovac, Zagreb
Institution Typology
Hospital
Country
Croatia
Description
BREATHING AGAINST RESISTANCE (PEP THERAPY Positive expiratory pressure) The benefits of incorporating Positive Expiratory Pressure (PEP) therapy into the management of respiratory infections, including those caused by SARS-CoV-2, can be numerous and significant. Improved Airway Clearance: PEP therapy helps mobilize secretions and mucus from the airways, facilitating their removal through coughing or suctioning. This can prevent mucus plugging, reduce the risk of atelectasis (lung collapse), and improve ventilation-perfusion matching, ultimately enhancing gas exchange and respiratory function. Enhanced Lung Expansion: By promoting deep breathing and lung inflation during therapy sessions, PEP therapy can improve lung compliance and prevent or alleviate areas of lung collapse or consolidation commonly seen in respiratory infections. This can help maintain lung volume, prevent respiratory muscle weakness, and reduce the risk of complications such as pneumonia or respiratory failure. Reduction of Respiratory Symptoms: PEP therapy can alleviate common respiratory symptoms associated with respiratory infections, including cough, dyspnea (shortness of breath), and chest congestion. By clearing mucus and improving airway patency, patients may experience relief from respiratory distress and discomfort, leading to improved overall quality of life. Prevention of Complications: Effective airway clearance and lung expansion with PEP therapy can help prevent complications such as respiratory infections, exacerbations of underlying lung conditions (e.g., chronic obstructive pulmonary disease), and secondary bacterial pneumonia, which are common in patients with respiratory infections like SARS-CoV-2. Facilitation of Respiratory Rehabilitation: PEP therapy can be an integral component of respiratory rehabilitation programs aimed at optimizing respiratory function, restoring physical capacity, and promoting functional independence in patients recovering from respiratory infections. By improving airway clearance and lung mechanics, PEP therapy can enhance the effectiveness of other rehabilitation interventions, such as exercise training and breathing exercises. Potential Reduction in Hospital Length of Stay: By promoting effective airway clearance and respiratory function, PEP therapy may contribute to shorter hospital stays and faster recovery times for patients with respiratory infections, including those hospitalized with severe COVID-19.
Disease
Covid19
Activity level
Low
Activity Typology
Rehabilitation section-based activities
Motivation Tools
Not available
Innovation
In critically ill patients, early physiotherapeutic treatment can facilitate breathing, alleviate symptoms, anxiety and sadness and prevent complications from worsening.
Evaluation System
The pulmonary interstitium in the group of patients requiring mechanical ventilation can be difficult to damage (low pressure and low tidal volume are used to minimize damage during ventilation). After mechanical ventilation is stopped, PEP therapy is used to help mobilize secretions from the lower to the upper lung segments. There are numerous devices with which this therapy is carried out.
Due to their weakened immune system, these patients are more susceptible to secondary bacterial infections, so treatment for them involves clearing bronchial secretions. Early physiotherapeutic therapies can prevent the development of fibrotic changes in the lung interstitium in milder stages of the disease, which can lead to impairment
Assessment
The benefits of PEP therapy in patients with respiratory infections like SARS-CoV-2 extend beyond mere symptom relief to encompass improved respiratory function, prevention of complications, and support for rehabilitation and recovery efforts. However, it's essential to individualize treatment approaches based on the patient's specific needs, clinical status, and response to therapy.
References
Benko S, et al. Recommendations for physiotherapy interventions in patients with SARS-COV-2 respiratory system infection. Avaliable at: www.pulmologija.hr/Content/Dokumenti/PREPORUKEZA_FIZIOTERAPEUTE_U_RADU_SA_COVID_19_BOLESNICIMA.pdf

www.physio-pedia.com/Positive_Expiratory_Pressure_(PEP)_Devices
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