Dique Filipeia: A rehabilitation protocol for non-intubated COVID-19 in-hospital patients

  1. Murillo Frazão
  2. Kamila Januária de Brito Marinho Paiva
  3. Rossana Maria da Nova Sá
  4. Fábio dos Santos Menezes
  5. Laís Ailenny dos Santos Alves
  6. Anderson Igor Silva de Souza Rocha
  7. Eduardo Eriko Tenório de França
  8. Amilton da Cruz Santos
  9. Maria do Socorro Brasileiro-Santos

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Objective

The aim of this study was to evaluate the effectiveness of the “Dique Filipeia” rehabilitation protocol in patients with COVID-19 admitted to reference hospitals.

Methods

This is an experimental study with COVID-19 patients admitted to the hospitals wards being considered eligible. The study outcomes were assessed between patients undergoing the rehabilitation protocol (Dique Filipeia group) and patients who did not receive the protocol (control group). The rehabilitation protocol consisted in classifying patients daily into four levels of severity through peripheral oxygen saturation. Severity was classified by the oxygen flow needed to maintain a saturation greater than or equal to the cut-off point of 93%. A standardized ventilatory support and functional rehabilitation exercises were performed for each severity level patient, followed by an attempt to wean oxygen.

Results

A total of 727 patients were analyzed in the study. The Dique Filipeia group presented a lower total (132.7 ± 35.3 vs 307.0 ± 114.3 m 3 /patient; effect size 1.73) and daily (2.9 ± 1.0 vs 6.8 ± 3.1 m 3 /day/patient; effect size 1.46) oxygen expenditure than the control group. The Dique Filipeia patients presented higher hospital discharge (64.9 ± 9.3 vs 35.4 ± 7.5%; effect size 3.46) and lower length of stay (15.8 ± 4.2 vs 29.1 ± 3.4 days; effect size 3.47) than the control group. The Dique Filipeia group patients, who were demanding oxygen therapy, were using 6.2 ± 4.3 L/min of oxygen at day 1. There was a statistically significant reduction from day 2 (p = 0.0001) and oxygen flow was reduced below 1L/min after day 7.

Conclusions

The implementation of a standardized rehabilitation protocol reduced oxygen expenditure, increased hospital discharge and reduced the length of hospital stay. Dique Filipeia is a practical, feasible and safe protocol.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2021.07.19.21258787: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: This study was approved by the local research ethics committee (Instituto de Educação Superior da Paraíba - IESP, opinion No. 4.777.641, CAAE: 47672821.8.0000.5184) and was registered in the Brazilian Clinical Trial Registration Platform (Number: RBR-107wv6d9).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    GraphPad Prism 7.0 and GPower 3.1.9.7 software programs were used for the statistical analysis.
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The major limitations to exercise (hypoxemia and dyspnea) were resolved by implementing oxygen and ventilatory support during low to moderate intensity exercise. It is important to emphasize that patients only performed the exercises in a safe condition (oxygen saturation > 93% and absence of dyspnea). If the safe condition was not reached, patients did not perform the exercise protocol. NIV and oxygen support reduces breathing work and respiratory muscles’ demand during exercise, increasing performance. O’Donell et al.(16) demonstrated that improvement is primarily explained by altered symptoms (reducing dyspnea and leg discomfort) and did not directly correlate with alterations in any of the measured cardiopulmonary physiological variables. Hospital discharge improvement and length of hospital stay reduction was achieved due to the combination of progressive oxygen weaning and the maintenance of the performance of physiological systems. Cardiorespiratory fitness and neuromuscular performance are directly affected by severe COVID-19(5). Exercise training helps keeping the physiological gears running. It prevents cardiac atrophy during the bed rest period(17), improving cardiovascular performance. It also improves strength and neuromuscular efficiency, even at moderate intensity(18), and reduces inflammatory markers(19). In patients who are not able to perform voluntary muscle contraction, neuromuscular electrical stimulation prevents muscle atrophy(20) and acutely mobilizes ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.07.19.21258787v1 on medRxiv