Rehabilitation of patients with platypnea-orthodeoxia syndrome in COVID-19 pneumonia: Two case reports
Shuen-Loong Tham, Poo Lee Ong, Audrey Jia Yi Lee, Matthew Rong Jie Tay
Rehabilitation Medicine, Tan Tock Seng Hospital, , Singapore, Singapore.
Platypnea-orthodeoxia syndrome, characterized by dyspnoea and arterial desaturation while upright, is a rare complication of acute respiratory distress syndrome. We report here 2 patients with COVID-19 pneumonia, who were diagnosed with platypnea-orthodeoxia syndrome during commence-ment of rehabilitation, 18 and 9 days respectively after admission to the intensive care unit. Both patients presented with normocapnic hypoxaemia. One patient required mechanical ventilation with supplemental oxygen during intensive care, while the other required high-flow nasal oxygen therapy. The manifestations of platypnea-orthodeoxia syndrome were most prominent during physiotherapy, when verticalization was attempted, and hindered further mobilization out of bed, including ambulation. This report describes the clinical manifestations of platypnea-orthodeoxia syndrome and the rehabilita-tive strategies carried out for these 2 patients. The platypnea-orthodeoxia syndrome in these patients resolved after 65 and 22 days respectively from the day of detection. This report highlights this potentially under-recognized phenomenon, which may be unmasked during rehabilitation of patients with COVID-19 pneumonia. Good functional outcomes were achieved with a combination of verticalization training with sup-plemental oxygen support, respiratory techniques training and progressive endurance and resistance training, whilst awaiting resolution of the platypnea-orthodeoxia syndrome.
Platypnea-orthodeoxia syndrome can be a rare complication in severe pneumonia. Patients with platypnea-orthodeoxia syndrome experience decreasing oxygen levels when assuming upright positions. This can interfere with walking and other activities that require an upright posture. We report here 2 patients with platypnea-orthodeoxia syndrome in severe COVID-19 pneumonia and describe their journey to recovery whilst undergoing rehabilitation and physical therapy. The various strategies that were helpful included the use of additional oxygen, special breathing tech-niques, as well as reducing the pace of the exercises delivered. By the end of their rehabilitation programmes, the 2 patients were able to walk without the need for additional oxygen. The platypnea-orthodeoxia syndrome resolved after 22 and 65 days from the day of detection.
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