This document outlines respiratory physiotherapy for COVID-19 in the hospital care. It includes physiotherapy screening, planning and implementing in the acute care setting caring for adult patients with suspected and/or confirmed COVID-19. Airway management of patients with COVID-19 is very essential and aimed to develop chest physiotherapy principles for airway management of patients with COVID-19 to encourage safe, accurate and better performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID-19, drawing on published literature and immediately available information from clinicians and experts.

Keywords: Corona virus, covid19, chest physiotherapy, rehabilitation.

1. Alhanzzi W, Moller MH, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19).
2. Diaz JH. Hypothesis: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may increase the risk of severe COVID-19. Journal of Travel Medicine, 2020.
3. Feng L, Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Res Med. (20)30116-8.
4. Jones, A., H.E. Montgomery, and D.R. Woods. Human performance: A role for the ACE genotype? Sport Sci. Rev., Vol. 30, No. 4, pp. 184–190, 2002.
5. Leung JM, Yang CX, et al. ACE-2 Expression in the Small Airway Epithelia of Smokers and COPD Patients: Implications for COVID-19.
6. Papazian, L., Aubron, C., Brochard, L. et al. Formal guidelines: management of acute respiratory distress syndrome. Intensive Care 9, 69 (2019).
7. Patel AB, Verma A. COVID-19 and Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: What Is the Evidence? March 24, 2020.
8. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, Hodgson C, Jones AYM, Kho ME, Moses R, Ntoumenopoulos G, Parry SM, Patman S, van der Lee L (2020): Physiotherapy management for COVID-19 in the acute hospital setting: Recommendations to guide clinical practice. Journal of Physiotherapy (2020).
9. Hodgson CL et al. Expert consensus and recommendations on safety criteria foractive mobilization of mechanically ventilated critically ill adults. Crit Care. 2014Dec 4; 18(6): 658.
10. Perme C, Chandrashekar R. Managing the patient on Mechanical Ventilation in ICU: Early Mobility and Walking Program. Acute Care Perspectives. Spring 2008, Vol 17, Number 1, 10-15.
11. Perme C, ChandrashekarR. Early mobility and walking program for patients in intensive care units: creating a standard of care.Am J Crit Care. 200918(3):212-21.
12. Australian and New Zealand Intensive Care Society, ANZICS COVID-19 Guidelines, 202, ANZICS: Melbourne.
13. Kress, J.P. and J.B. Hall, ICU-acquired weakness and recovery from critical illness. N Engl J Med, 2014. 370(17): p. 1626-35.
14. Herridge, M.S., C.M. Tansey, A. Matte, G. Tomlinson, N. Diaz-Granados, A. Cooper, C.B. Guest, C.D. Mazer, S. Mehta, T.E. Stewart, P. Kudlow, D. Cook, A.S. Slutsky, and A.M.Cheung, Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med, 2011. 364(14): p. 1293-304.
15. Brouwers, M.C., M.E. Kho, G.P. Browman, J.S. Burgers, F. Cluzeau, G. Feder, B. Fervers, I.D. Graham, S.E. Hanna, and J. Makarski, Development of the AGREE II, part 1:performance, usefulness and areas for improvement. Cmaj, 2010.182(10): p. 1045-52.
16. Moberg, J., A.D. Oxman, S. Rosenbaum, H.J. Schunemann, G. Guyatt, S. Flottorp, C. Glenton, S. Lewin, A. Morelli, G. Rada, and P. Alonso-Coello, The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst, 2018.16(1): p. 45.
17. World Health Organisation, Infection prevention and control during health care when COVID-19 is suspected: Interim Guidance, M. 2020, Editor 2020.
18. Respiratory Health for Better COVID-19 Outcomes Blake Elias, Chen Shen and Yaneer Bar-Yam New England Complex Systems Institute March 16, 2020.
19. US Centers for Disease Control and Prevention. Preventing the Spread of Coronavirus Disease 2019 in Homes and Residential Communities, February 14, 2020.
20. Sven Britton, Margareta Bejstedt, and Lars Vedin. Chest physiotherapy in primary pneumonia. Br Med J (Clin Res Ed), 290(6483):1703–1704, 1985.
21. Medline Plus .Exercise and immunity, accessed March 15, 2020. https://medlineplus.gov/ency/article/007165.htm
22. Respiratory physiotherapy in patients with COVID-19 setting:a position paper of the Italian association of physiotherapists (ARIR) Marts Lazzzeri, Andrea Lanza, Raffaella Bellini, Angele Bellofiore, EMILIA privitera, Mariangela Retucci Monalrchives for chest disease 2020: volume 90:2085.

E.Chandramouli

Lecturer in Physiotherapy, Rajah Muthiah Medical College and Hospital, Annamalai University, Tamilnadu, India