pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2020-30-5-715-722pulmo-1375Research ArticleЗАМЕТКИ ИЗ ПРАКТИКИPRACTICAL NOTESЛегочная реабилитация пациентов, перенесших коронавирусную инфекцию COVID-19 (клинические примеры)Pulmonary rehabilitation of patients with coronavirus infection COVID-19, clinical examplesМещеряковаН. Н.MeshcheryakovaN. N.

Мещерякова Наталья Николаевна – к. м. н., доцент кафедры пульмонологии факультета дополнительного профессионального образования Федерального государственного автономного образовательного учреждения высшего образования «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Министерства здравоохранения Российской Федерации; врач-пульмонолог Клиники респираторной медицины «ИнтеграМед»

 

Natalya N. Meshcheryakova – Candidate of Medicine, Associate Professor of the Department of Pulmonology, Faculty of Postgraduate Physician Training, N.I.Pirogov Russian National Research Medical University, Healthcare Ministry of Russia; pulmonologist at “IntegraMed” Respiratory Medicine Clinic

Ostrovityanova 1, Moscow, 117997Mazhorov per. 7, Moscow, 107023tel.: (903) 744-24-63

m_natalia1967@inbox.ruБелевскийА. С.BelevskiyA. S.

Белевский Андрей Станиславович – д. м. н., профессор, заведующий кафедрой пульмонологии факультета дополнительного профессионального образования

117997, Москва, ул. Островитянова, 1тел.: (495) 963-24-67

Andrey S. Belevsky – Doctor of Medicine, Professor, Head of the Department of Pulmonology, Faculty of Postgraduate Physician Training

Ostrovityanova 1, Moscow, 117997tel.: (495) 963-24-67

pulmobas@yandex.ruКулешовА. В.KuleshovA. V.

Кулешов Андрей Владимирович – к. м. н., главный врач Клиники респираторной медицины

107023, Москва, Мажоров переулок, 7тел.: (903)130-59-02

Andrey V. Kuleshov – Candidate of Medicine, Chief Physician

Mazhorov per. 7, Moscow, 107023tel.: (903) 130-59-02

kuleshov@integramed.infoФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Министерства здравоохранения Российской Федерации; Клиника респираторной медицины «ИнтеграМед»РоссияN.I.Pirogov Federal Russian National Research Medical University, Healthcare Ministry of Russia; “IntegraMed” Respiratory Medicine ClinicRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Министерства здравоохранения Российской ФедерацииРоссияN.I.Pirogov Federal Russian National Research Medical University, Healthcare Ministry of RussiaRussian FederationКлиника респираторной медицины «ИнтеграМед»Россия“IntegraMed” Respiratory Medicine ClinicRussian Federation202026102020305715722Copyright © Мещерякова Н.Н., Белевский А.С., Кулешов А.В., 20202020Мещерякова Н.Н., Белевский А.С., Кулешов А.В.Meshcheryakova N.N., Belevskiy A.S., Kuleshov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1375

В конце 2019 года в Китайской Народной Республике произошла вспышка новой коронавирусной инфекции с эпицентром в городе Ухань. Всемирная организация здравоохранения 11.02.20 присвоила официальное название инфекции, вызванной новым коронавирусом, COVID-19 (CОronaVIrus Disease­2019). Международный комитет по таксономии вирусов 11.02.20 присвоил название возбудителю инфекции SARS-CoV-2. В настоящее время известно, что наиболее распространенным клиническим проявлением варианта коронавирусной инфекции является двусторонняя пневмония, у 3–4 % пациентов зарегистрировано развитие острого респираторного дистресссиндрома. При пневмонии у пациентов развиваются вентиляционно-перфузионные нарушения, слабость скелетной мускулатуры. Для восстановления пациентов после вирусной пневмонии необходима легочная реабилитация. В данной статье приведены методы легочной реабилитации, направленные на улучшение кровообращения в легких, вентиляционно-перфузионных отношений, восстановление работы скелетной мускулатуры.

At the end of 2019, an outbreak of a new coronavirus infection was identified in the People’s Republic of China centerd in the city of Wuhan. The official name COVID-19 (COronaVIrus Disease 2019) was assigned to the infection caused by the novel coronavirus by the World Health Organization on February 11, 2020. The International Committee on Taxonomy of Viruses assigned the name to the causative agent of the infection – SARS-CoV-2 on February 11, 2020. The bilateral pneumonia is currently known to be the most common clinical manifestation of the variant of coronavirus infection. The development of acute respiratory distress syndrome was found in 3 – 4% of patients. As a result of pneumonia, patients develop ventilation and perfusion disorders, weakness of skeletal muscles. To recover patients after viral pneumonia, methods of pulmonary rehabilitation should be applied. This article represents the methods of pulmonary rehabilitation aimed to improve the blood circulation in the lungs, the ventilation-perfusion ratios, and to the restoration of the skeletal muscles.

новая коронавирусная инфекция COVID-19инфекция SARS-CoV-2внебольничная пневмониялегочная реабилитацияnew coronavirus infection COVID-19SARS-CoV-2 infectioncommunity-acquired pneumoniapulmonary rehabilitationReferencesМинистерство здравоохранения Российской Федерации. Временные методические рекомендации: Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). Версия 7 (03.06.2020). Доступно на: https://static-0.rosminzdrav.ru/system/attachments/attaches/000/050/584/original/03062020_%D0%9CR_COVID-19_v7.pdfMinistry of Health of the Russian Federation. [Temporary guidelines: Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 7 (03.06.2020)]. Available at: https://static-0.rosminzdrav.ru/system/attachments/attaches/000/050/584/original/03062020_%D0%9CR_COVID-19_v7.pdf (in Russian).Baig A.M. Khaleeq A., Ali U. et al. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host–virus interaction, and proposed neurotropic mechanisms. ACS Chem. Neurosci. 2020; 11 (7): 995–998. DOI: 10.1021/acschemneuro.0c00122.Baig A.M. Khaleeq A., Ali U. et al. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host–virus interaction, and proposed neurotropic mechanisms. ACS Chem. Neurosci. 2020; 11 (7): 995–998. DOI: 10.1021/acschemneuro.0c00122.Behzadi M.A., Leyva-Grado V.H. Overview of current therapeutics and novel candidates against influenza, respiratory syncytial virus, and Middle East respiratory syndrome coronavirus infections. Front. Microbiol. 2019; 10: 1327. DOI: 10.3389/fmicb.2019.01327.Behzadi M.A., Leyva-Grado V.H. Overview of current therapeutics and novel candidates against influenza, respiratory syncytial virus, and Middle East respiratory syndrome coronavirus infections. Front. Microbiol. 2019; 10: 1327. DOI: 10.3389/fmicb.2019.01327.Covernment of Canada. Coronavirus disease (COVID-19): Symptoms and treatment. Available at: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms.htmlCovernment of Canada. Coronavirus disease (COVID-19): Symptoms and treatment. Available at: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms.htmlCDC: Center for Disease Control and Prevention. Coronavirus disease 2019. Available at: https://www.cdc.gov/coronavirus/2019-ncov/index.htmlCDC: Center for Disease Control and Prevention. Coronavirus disease 2019. Available at: https://www.cdc.gov/coronavirus/2019-ncov/index.htmlChen N., Zhou M., Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395 (10223): 507–513. DOI: 10.1016/S0140-6736(20)30211-7.Chen N., Zhou M., Dong X. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395 (10223): 507–513. DOI: 10.1016/S0140-6736(20)30211-7.Nici L., Donner C., Wouters E. et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am. J. Respir. Crit. Care Med. 2006; 173(12): 1390–1413. DOI: 10.1164/rccm.200508-1211st.Nici L., Donner C., Wouters E. et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am. J. Respir. Crit. Care Med. 2006; 173 (12): 1390–1413. DOI: 10.1164/rccm.200508-1211st.Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. Update 2013. Available at: https://goldcopd.org/Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. Update 2013. Available at: https://goldcopd.org/Исаев Г.Г. Физиология дыхательных мышц. В кн.: Бреслав И.С., Исаев Г.Г., ред. Физиология дыхания. СПб: Наука; 1994: 178–197.Isaev G.G. [Respiratory muscle physiology]. In: Breslav I.S., Isaev G.G., eds. [Respiratory Physiology]. St. Petersburg: Nauka; 1994: 178–197 (in Russian).McConnell A. Breathe Strong Perform Better. Human Kinetics; 2011.McConnell A. Breathe Strong Perform Better. Human Kinetics; 2011.American Thoracic Society/European Respiratory Society. ATS/ERS statement on respiratory muscle testing. Am. J. Respir. Crit. Care Med. 2002; 166 (4): 518–624. DOI: 10.1164/rccm.166.4.518.American Thoracic Society/European Respiratory Society. ATS/ERS statement on respiratory muscle testing. Am. J. Respir. Crit. Care Med. 2002; 166 (4): 518–624. DOI: 10.1164/rccm.166.4.518.Black L.F., Hyatt R.E. Maximal inspiratory pressures: normal values and relationship to age and sex. Am. Rev. Respir. Dis. 1969; 99: 696–702.Black L.F., Hyatt R.E. Maximal inspiratory pressures: normal values and relationship to age and sex. Am. Rev. Respir. Dis. 1969; 99: 696–702.Caine M.P., McConnell A.K. Development and evaluation of a pressure threshold inspiratory muscle trainer for use in the context of sports performance. J. Sports Engineer. 2000; 3 (3): 149–159. DOI: 10.1046/j.1460-2687.2000.00047.x.Caine M.P., McConnell A.K. Development and evaluation of a pressure threshold inspiratory muscle trainer for use in the context of sports performance. J. Sports Engineer. 2000; 3 (3): 149–159. DOI: 10.1046/j.1460-2687.2000.00047.x.Edwards A.M., Wells C., Butterly R. Concurreny inspiratory muscle and cardiovascular training differentially improves both perceptions of effort and 5000 m running performance compared with cardiovascular training alone. Br. J. Sports Med. 2004; 42 (10): 523–527. DOI: 10.1136/bjsm.2007.045377.Edwards A.M., Wells C., Butterly R. Concurreny inspiratory muscle and cardiovascular training differentially improves both perceptions of effort and 5000 m running performance compared with cardiovascular training alone. Br. J. Sports Med. 2004; 42 (10): 523–527. DOI: 10.1136/bjsm.2007.045377.Enright S.J., Unnithan V.B., Heward C. et al. Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy. Phys. Ther. 2006; 86 (3): 345–354. DOI: 10.1093/ptj/86.3.345.Enright S.J., Unnithan V.B., Heward C. et al. Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy. Phys. Ther. 2006; 86 (3): 345–354. DOI: 10.1093/ptj/86.3.345.Epstein S.K. An overview of respiratory muscle function. Clin. Chest. Med. 1994; 15 (4): 619–639.Epstein S.K. An overview of respiratory muscle function. Clin. Chest. Med. 1994; 15 (4): 619–639.Gregory C.M., Bickel C.S. Recruitment pattern in Himan skeletal muscle during electrical stimulation. Phys. Ther. 2005; 85 (4): 358–364. DOI: 10.1093/ptj/85.4.358.Gregory C.M., Bickel C.S. Recruitment pattern in Himan skeletal muscle during electrical stimulation. Phys. Ther. 2005; 85 (4): 358–364. DOI: 10.1093/ptj/85.4.358.Requena Sánchez B., Padial Puche P., Gonzalez-Badillo J.J. Percutaneous electrical stimulation in strength training: an update. J. Strength Cond. Res. 2005; 19 (2): 438–441.Requena Sánchez B., Padial Puche P., Gonzalez-Badillo J.J. Percutaneous electrical stimulation in strength training: an update. J. Strength Cond. Res. 2005; 19 (2): 438–441.Geddes E.L., O’Brien K., Reid W.D. et al. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review. Respir. Med. 2008; 102 (12): 1715–1729. DOI: 10.1016/j.rmed.2008.07.005.Geddes E.L., O’Brien K., Reid W.D. et al. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review. Respir. Med. 2008; 102 (12): 1715–1729. DOI: 10.1016/j.rmed.2008.07.005.Gosselink R., De Vos J., van den Heuvel S.P. et al. Impact of inspiratory muscle training in patients with COPD: what is the evidence? Eur. Respir. J. 2011; 37 (2): 416–425. DOI: 10.1183/09031936.00031810.Gosselink R., De Vos J., van den Heuvel S.P. et al. Impact of inspiratory muscle training in patients with COPD: what is the evidence? Eur. Respir. J. 2011; 37 (2): 416–425. DOI: 10.1183/09031936.00031810.O’Brien K., Geddes E.L., Reid W.D. et al. Inspiratory muscle training compared with other rehabilitation interventions in chronic obstructive pulmonary disease: A systematic review update. J. Cardiopulm. Rehabil. Prev. 2008; 28 (2): 128–141. DOI: 10.1097/01.hcr.0000314208.40170.00.O’Brien K., Geddes E.L., Reid W.D. et al. Inspiratory muscle training compared with other rehabilitation interventions in chronic obstructive pulmonary disease: A systematic review update. J. Cardiopulm. Rehabil. Prev. 2008; 28 (2): 128–141. DOI: 10.1097/01.hcr.0000314208.40170.00.Lötters F., van Tol B., Kwakkel G. et al. Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis. Eur. Respir. J. 2002; 20 (3): 570–576. DOI: 10.1183/09031936.02.00237402.Lötters F., van Tol B., Kwakkel G. et al. Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis. Eur. Respir. J. 2002; 20 (3): 570–576. DOI: 22. Lötters F., van Tol B., Kwakkel G. et al. Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis. Eur. Respir. J. 2002; 20 (3): 570–576. DOI: 10.1183/09031936.02.00237402.Hill K., Jenkins S.C., Philippe D.L. et al. High-intensity inspiratory muscle training in COPD. Eur. Respir. J. 2006; 27 (6): 1119–1128.Hill K., Jenkins S.C., Philippe D.L. et al. High-intensity inspiratory muscle training in COPD. Eur. Respir. J. 2006; 27 (6): 1119–1128.Meshcheriakova N., Belevskiy A., Cherniak A. et al. Threshold PEP and IMT devices (PID) for COPD patient respiratory training. Eur. Respir. J. [Abstracts 16 th ERS Annual Congress. Munich, Germany, 2–6 September, 2006]. 2006; 28 (Suppl. 50): S553.Meshcheriakova N., Belevskiy A., Cherniak A. et al. Threshold PEP and IMT devices (PID) for COPD patient respiratory training. Eur. Respir. J. [Abstracts 16 th ERS Annual Congress. Munich, Germany, 2–6 September, 2006]. 2006; 28 (Suppl. 50): S553.Kempainen R.R., Milla C., Duniz J. et al. Comparison of setting used for high-freguency chest-wall compression in cyctic fibrosis. Respir. Care. 2010; 55 (6): 782–783.Kempainen R.R., Milla C., Duniz J. et al. Comparison of setting used for high-freguency chest-wall compression in cyctic fibrosis. Respir. Care. 2010; 55 (6): 782–783.Allan J.S., Garrity G.M., Donahue D.M. High-freguency chest-wall compression during the 48 hours following thoracic surgery. Respir. Care. 2009; 54 (3): 340–343.Allan J.S., Garrity G.M., Donahue D.M. High-freguency chest-wall compression during the 48 hours following thoracic surgery. Respir. Care. 2009; 54 (3): 340–343.Nicolini A., Cardini F., Landucci N. et al. Effectiveness of treatment with high-frequency chest wall ascillation in patients with bronchiectasis. BMC Pulm. Med. 2013; 13 (1): 21. DOI: 10.1186/1471-2466-13-21.Nicolini A., Cardini F., Landucci N. et al. Effectiveness of treatment with high-frequency chest wall ascillation in patients with bronchiectasis. BMC Pulm. Med. 2013; 13 (1): 21. DOI: 10.1186/1471-2466-13-21.Gloeck R., Heinzeimann I., Baeuerle S. et al. Effects of whole body vibration in patients with chronic obstructive pulmonary disease: A randomized controlled trial. Respir. Med. 2012; 106 (1): 75–83. DOI: 10.1016/j.rmed.2011.10.021.Gloeck R., Heinzeimann I., Baeuerle S. et al. Effects of whole body vibration in patients with chronic obstructive pulmonary disease: A randomized controlled trial. Respir. Med. 2012; 106 (1): 75–83. DOI: 10.1016/j.rmed.2011.10.021.Brugliera L., Spina A., Castellazzi P. et al. Rehabilitation of COVID-19 patients. J. Rehabil. Med. 2020; 52 (4): jrmo00046. DOI: 10.2340/16501977-2678.Brugliera L., Spina A., Castellazzi P. et al. Rehabilitation of COVID-19 patients. J. Rehabil. Med. 2020; 52 (4): jrmo00046. DOI: 10.2340/16501977-2678.Bryant M.S., Fedson S.E., Sharafkhaneh A. Using telehealth cardiopulmonary rehabilitation during the COVID-19 pandemic. J. Med. Syst. 2020; 44 (7): 125. DOI: 10.1007/s10916-020-01593-8.Bryant M.S., Fedson S.E., Sharafkhaneh A. Using telehealth cardiopulmonary rehabilitation during the COVID-19 pandemic. J. Med. Syst. 2020; 44 (7): 125. DOI: 10.1007/s10916-020-01593-8.De Biase S., Cook L., Skelton D.A. et al. The COVID-19 rehabilitation pandemic. Age Ageing. 2020; 49 (5): 696–700. DOI: 10.1093/ageing/afaa118.De Biase S., Cook L., Skelton D.A. et al. The COVID-19 rehabilitation pandemic. Age Ageing. 2020; 49 (5): 696–700. DOI: 10.1093/ageing/afaa118.Bettger J.P., Thoumi A., Marguevich W. et al. COVID-19: maintain essential rehabilitation services across the care continuum. BMJ Glob. Heath. 2020; 5 (5): e002670. DOI: 10.1136/bmjgh-2020-002670.Bettger J.P., Thoumi A., Marguevich W. et al. COVID-19: maintain essential rehabilitation services across the care continuum. BMJ Glob. Heath. 2020; 5 (5): e002670. DOI: 10.1136/bmjgh-2020-002670.Carda S., Invernizzi M., Bavikatte G. The role of physical and rehabilitation medicine in the COVID-19 pandemic: The clinician’s view. Ann. Phys. Rehabil. Med. 2020; 99 (6): 459–463. DOI: 10.1097/phm.0000000000001452.Carda S., Invernizzi M., Bavikatte G. The role of physical and rehabilitation medicine in the COVID-19 pandemic: The clinician’s view. Ann. Phys. Rehabil. Med. 2020; 99 (6): 459–463. DOI: 10.1097/phm.0000000000001452.

The authors declare that there are no conflicts of interest present.