Breathing exercise. Exercise can fully expand
Posted: Sun Feb 02, 2025 8:45 am
Creation of a dynamic mechanism for assessing and preventing psychological crisis
The mental state of patients (individual psychological stress, mood, sleep quality and pressure) should be monitored weekly after admission and before discharge. The assessment tools include: Self-Report Questionnaire 20 (SRQ-20), Patient Health Questionnaire 9 (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7). The expert rating tools include: Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS). In special environments such as isolated wards, we suggest that patients should be guided to complete the questionnaires via their mobile phones. Physicians can interview and assess the scale through face-to-face or online discussion.
3 Assessment-based intervention and treatment
3.1 Principles of intervention and treatment
For non-complicated patients, psychological intervention is suggested. Psychological self-tuning includes breathing relaxation training and mindfulness training. For moderate to severe patients, intervention and treatment is suggested through a combination of medication and psychotherapy. Newer antidepressants, anxiolytics, and benzodiazepines can be prescribed to improve mood and sleep quality. Second-generation antipsychotics such as olanzapine and quetiapine can be used to reduce psychotic symptoms such as delusions and delusions.
3.2 Recommendations for the use of psychotropic drugs in elderly patients
The medical situations of middle-aged or elderly patients with COVID-19 are often complicated by physical diseases such as hypertension and diabetes. Therefore, when choosing psychotropic drugs, it is necessary to fully consider drug interactions and their impact on breathing. We recommend using citalopram, escitalopram, etc. to improve symptoms of depression and anxiety; benzodiazepines such as estazolam, alprazolam, etc. to relieve anxiety and improve sleep quality; olanzapine, quetiapine, etc. to reduce psychotic symptoms.
XV. Rehabilitation therapy for COVID-19 patients
Critically ill and severely ill patients suffer from varying degrees of dysfunction, especially respiratory failure, dyskinesia and cognitive impairment, both in the acute and recovery periods.
1 Rehabilitation therapy for severely and critically ill patients
The goal of early rehabilitation intervention is to improve breathing, relieve symptoms, reduce anxiety and depression, and reduce the incidence of complications. The process of early rehabilitation intervention is as follows: rehabilitation assessment, therapy reassessment.
1.1 Rehabilitation assessment
Based on the General Clinical Assessment, special attention should be paid to the functional assessment, including respiration, cardiac status, movement, and ADL. Focus on the respiratory rehabilitation assessment, which includes the assessment of chest activity, diaphragm activity amplitude, respiratory pattern and frequency, etc.
1.2 Rehabilitation therapy
Rehabilitation therapy for severe or critically ill COVID-19 patients mainly includes positional control, breathing training and physical therapy.
Postural management. Postural drainage can reduce the impact of sputum on the airway, which is especially important for improving the ventilation-perfusion index. Patients should learn to lean into a position that allows gravity to assist in the drainage of secretions from the lung lobes or lung segments. For patients using sedatives and suffering from impaired consciousness, a standing bed or bed head elevation (30°-45°-60°) can be used if the patient's condition allows. Standing is the best body position for breathing at rest, which can effectively improve the patient's respiratory efficiency and maintain lung capacity. If the patient feels well, he should adopt a standing position and gradually increase the standing time.
the lungs, help the secretions from the pulmonary alveoli and airways to be expelled into the large airways, so that the sputum does not accumulate at the bottom of the lungs. It increases vital capacity and strengthens lung function. Deep slow breathing and chest expansion breathing combined with shoulder expansion are the two main breathing exercise techniques.
- Deep slow breathing: During inhalation, the patient should japan number data try his best to actively move the diaphragm. Breathing should be as deep and slow as possible to avoid the decrease in breathing efficiency caused by rapid shallow breathing. Compared with thoracic breathing, this type of breathing requires less muscle strength, but has a better tidal volume and ventilation-perfusion index value, which can be used to adjust breathing when short of breath.
- Chest expansion breathing combined with shoulder expansion: Increase pulmonary ventilation. When you take a deep slow breath, you expand your chest and shoulders during inhalation; and move your chest and shoulders back while exhaling. Due to the special pathological factors of viral pneumonia, holding your breath for a long time should be avoided, so as not to increase the load on the respiratory function and heart, as well as oxygen consumption. In the meantime, try not to move too quickly. Adjust the breathing rate to 12-15 times / min.
Active cycle of breathing techniques. It can effectively remove bronchial secretion and improve lung function without worsening
hypoxemia and airflow obstruction. It consists of three stages (breathing control, chest expansion and exhalation). The flow
to form the breathing cycle should be developed according to the patient's condition.
Positive expiratory pressure simulator. The pulmonary interstitial tissue of COVID-19 patients has been severely damaged. Low pressure and low tidal volume are required during mechanical ventilation to avoid damage to the pulmonary interstitium. Therefore, after removing the mechanical ventilation, a positive expiratory pressure simulator can be used to help the secretions move from the low-volume segments of the lungs to the high-volume segments, reducing the difficulty of expectoration. Positive expiratory pressure can be generated by the vibration of the airflow, which vibrates the airway to achieve airway support. Then the residue can be removed as the high-speed expiratory flow moves it.
Exercise therapy includes ultra-short waves, oscillators, external membrane pacemaker, electrical muscle stimulation, etc.
The mental state of patients (individual psychological stress, mood, sleep quality and pressure) should be monitored weekly after admission and before discharge. The assessment tools include: Self-Report Questionnaire 20 (SRQ-20), Patient Health Questionnaire 9 (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7). The expert rating tools include: Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS). In special environments such as isolated wards, we suggest that patients should be guided to complete the questionnaires via their mobile phones. Physicians can interview and assess the scale through face-to-face or online discussion.
3 Assessment-based intervention and treatment
3.1 Principles of intervention and treatment
For non-complicated patients, psychological intervention is suggested. Psychological self-tuning includes breathing relaxation training and mindfulness training. For moderate to severe patients, intervention and treatment is suggested through a combination of medication and psychotherapy. Newer antidepressants, anxiolytics, and benzodiazepines can be prescribed to improve mood and sleep quality. Second-generation antipsychotics such as olanzapine and quetiapine can be used to reduce psychotic symptoms such as delusions and delusions.
3.2 Recommendations for the use of psychotropic drugs in elderly patients
The medical situations of middle-aged or elderly patients with COVID-19 are often complicated by physical diseases such as hypertension and diabetes. Therefore, when choosing psychotropic drugs, it is necessary to fully consider drug interactions and their impact on breathing. We recommend using citalopram, escitalopram, etc. to improve symptoms of depression and anxiety; benzodiazepines such as estazolam, alprazolam, etc. to relieve anxiety and improve sleep quality; olanzapine, quetiapine, etc. to reduce psychotic symptoms.
XV. Rehabilitation therapy for COVID-19 patients
Critically ill and severely ill patients suffer from varying degrees of dysfunction, especially respiratory failure, dyskinesia and cognitive impairment, both in the acute and recovery periods.
1 Rehabilitation therapy for severely and critically ill patients
The goal of early rehabilitation intervention is to improve breathing, relieve symptoms, reduce anxiety and depression, and reduce the incidence of complications. The process of early rehabilitation intervention is as follows: rehabilitation assessment, therapy reassessment.
1.1 Rehabilitation assessment
Based on the General Clinical Assessment, special attention should be paid to the functional assessment, including respiration, cardiac status, movement, and ADL. Focus on the respiratory rehabilitation assessment, which includes the assessment of chest activity, diaphragm activity amplitude, respiratory pattern and frequency, etc.
1.2 Rehabilitation therapy
Rehabilitation therapy for severe or critically ill COVID-19 patients mainly includes positional control, breathing training and physical therapy.
Postural management. Postural drainage can reduce the impact of sputum on the airway, which is especially important for improving the ventilation-perfusion index. Patients should learn to lean into a position that allows gravity to assist in the drainage of secretions from the lung lobes or lung segments. For patients using sedatives and suffering from impaired consciousness, a standing bed or bed head elevation (30°-45°-60°) can be used if the patient's condition allows. Standing is the best body position for breathing at rest, which can effectively improve the patient's respiratory efficiency and maintain lung capacity. If the patient feels well, he should adopt a standing position and gradually increase the standing time.
the lungs, help the secretions from the pulmonary alveoli and airways to be expelled into the large airways, so that the sputum does not accumulate at the bottom of the lungs. It increases vital capacity and strengthens lung function. Deep slow breathing and chest expansion breathing combined with shoulder expansion are the two main breathing exercise techniques.
- Deep slow breathing: During inhalation, the patient should japan number data try his best to actively move the diaphragm. Breathing should be as deep and slow as possible to avoid the decrease in breathing efficiency caused by rapid shallow breathing. Compared with thoracic breathing, this type of breathing requires less muscle strength, but has a better tidal volume and ventilation-perfusion index value, which can be used to adjust breathing when short of breath.
- Chest expansion breathing combined with shoulder expansion: Increase pulmonary ventilation. When you take a deep slow breath, you expand your chest and shoulders during inhalation; and move your chest and shoulders back while exhaling. Due to the special pathological factors of viral pneumonia, holding your breath for a long time should be avoided, so as not to increase the load on the respiratory function and heart, as well as oxygen consumption. In the meantime, try not to move too quickly. Adjust the breathing rate to 12-15 times / min.
Active cycle of breathing techniques. It can effectively remove bronchial secretion and improve lung function without worsening
hypoxemia and airflow obstruction. It consists of three stages (breathing control, chest expansion and exhalation). The flow
to form the breathing cycle should be developed according to the patient's condition.
Positive expiratory pressure simulator. The pulmonary interstitial tissue of COVID-19 patients has been severely damaged. Low pressure and low tidal volume are required during mechanical ventilation to avoid damage to the pulmonary interstitium. Therefore, after removing the mechanical ventilation, a positive expiratory pressure simulator can be used to help the secretions move from the low-volume segments of the lungs to the high-volume segments, reducing the difficulty of expectoration. Positive expiratory pressure can be generated by the vibration of the airflow, which vibrates the airway to achieve airway support. Then the residue can be removed as the high-speed expiratory flow moves it.
Exercise therapy includes ultra-short waves, oscillators, external membrane pacemaker, electrical muscle stimulation, etc.