Rehabilitation of mechanically ventilated elderly patient with COVID-19 of a dedicated COVID tertiary hospital: a case report

Rachna D. Arora, Rajvi D. Sheth, Abhishek Gupta


Corona virus disease 2019 (COVID-19), a highly communicable disease caused by severe acute respiratory syndrome-corona virus 2 (SARS-CoV2) which originated in Wuhan, China has affected 213 countries worldwide and has caused an economic crisis. As of August 10, 2020, India’s recovery rate is 63%. Most of the critical cases requiring intensive care unit (ICU) management are elderly patients with co-morbidities. The case report is of an elderly, comorbid patient who was intubated and put on a mechanical ventilator. At a time when critical patients on mechanical ventilator hardly survived, this patient survived and was successfully weaned from the ventilator and extubated. The case report emphasizes physical therapy management along with medical management for an elderly SARS CoV2 survivor with co-morbidities, and his journey from the onset of symptoms to being mechanically ventilated to performing his daily activities with minimal discomfort.



COVID-19, SARS-CoV-2, Mechanical ventilation, Physical therapy, Early mobilization, Pulmonary rehabilitation

Full Text:



WHO. Modes of transmission of virus causing COVID-19: Implications for IPC precaution recommendations. 2020. Available at: https://www. detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations. Accessed on 09 August 2020.

Nanda A, Vura NV, Gravenstein S. COVID-19 in older adults. Aging Clin Exp Res. 2020;10:1-4.

Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing. J Med Virol. 2020;92(7):797-806.

Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: A Nationwide Analysis. Eur Respir J. 2020;55(5):2000547.

Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109(5):531-8.

Wang Y, Lu X, Li Y, Chen H, Chen T, Su N, et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med. 2020;201(11):1430-4.

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052-9.

Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-10.

Castro AA, Calil SR, Freitas SA, Oliveira AB, Porto EF. Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients. Respir Med. 2013;107(1):68-74.

Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: Recommendations to guide clinical practice. J Physiother. 2020;66(2):73-82.

Barba C, Cavalli-Sforza T, Cutter J, Darnton-Hill I, Deurenberg P, Deurenberg-Yap M, et al. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-63.

Munari AB, Gulart AA, Dos Santos K, Venâncio RS, Karloh M, Mayer AF. Modified Medical Research Council dyspnea scale in GOLD classification better reflects physical activities of daily living. Respir Care. 2018;63(1):77-85.

Hindustan Times. One-third of Covid deaths a result of delay in admission or reporting: Maharashtra task force. 2020. Available at: https://www.hindust hs-a-result-of-delay-in-admission-or-reporting-maharashtra-task-force/story-YfsA3NDVIz93znvghUtkmN.html. Accessed on: 10 August 2020.

Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.

Voinsky I, Baristaite G, Gurwitz D. Effects of age and sex on recovery from COVID-19: analysis of 5769 Israeli patients. J Infect. 2020;81(2):102-3.

Costa FF, Rosário WR, Farias AC, de Souza RG, Gondim RS, Barroso WA. Metabolic syndrome and COVID-19: An update on the associated comorbidities and proposed therapies. Diabetes Metab Syndr. 2020;14(5):809-14.

Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med. 2012;186(8):724-31.

Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, et al. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PloS one. 2019;14(10):e0223185.

Public Health England. Guidance COVID-19: personal protective equipment use for aerosol generating procedures. 2020. Available at: Accessed on 10 August 2020.

Berney S, Haines K, Denehy L. Physiotherapy in critical care in Australia. Cardiopulm Phys Ther J. 2012;23(1):19.

Pelosi P, Brazzi L, Gattinoni L. Prone position in acute respiratory distress syndrome. Eur Respir J. 2002;20(4):1017-28.

Verma CV, Arora RD, Shetye JV, Karnik ND, Patil PC, Mistry HM, et al. Guidelines of physiotherapy management in acute care of COVID-19 at dedicated COVID-19 centre in Mumbai. Physiother-J Indian Assoc Physiother. 2020;14:55-60.

Guidelines for Chest Physiotherapy management of COVID-19 in Indian Set-up – MS OTPT Council (2020). 2020. Available at: Accessed on: 10 August 2020.

Burk RS, Grap MJ. Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: conflicting recommendations. Heart Lung. 2012;41(6):536-45.

Radaelli A, Raco R, Perfetti P, Viola A, Azzellino A, Signorini MG, et al. Effects of slow, controlled breathing on baroreceptor control of heart rate and blood pressure in healthy men. J Hypertens. 2004;22(7):1361-70.

Katz S, Arish N, Rokach A, Zaltzman Y, Marcus EL. The effect of body position on pulmonary function: a systematic review. BMC Pulm Med. 2018;18(1):1-6.