PMC8274657_01
Computed tomography scan before and after hospitalization and before regional hospital transfer. Computed tomography scan images taken (A) 1 week prior to hospitalization, (B) on hospital day 1, and (C) before regional hospital transfer.
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F1
His chest computed tomography scan on admission showed an emphysematous lung with diffuse slit-glass shadows and infiltrative shadows on the dorsal side (Figure 1). We suspected COPD because of his 50-year smoking history (Figure 1).
Timeline of the patient's respiratory management and rehabilitation programs. Data recorded in the management of the patient's pulmonary condition included the PaO2/FiO2 ratio and Sequential Organ Failure Assessment score. Indicated are the rehabilitation programs used between admission (day 1) and the day of regional hospital transfer (day 18). CMV, continuous mandatory ventilation; CPAP, continuous positive airway pressure; HNFC, high-flow nasal cannula; PCV, pressure-controlled ventilation; RASS, Richmond Agitation-Sedation Scale; ROM, range of motion.
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F2
A timeline of the patient's respiratory management and the rehabilitation programs is shown in Figure 2.
A representative rehabilitation scene. The patient (A) sitting on the edge of the bed at the beginning of rehabilitation (day 3) and (B) performing half-squats and calf-raises before regional hospital transfer (day 18).
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F3
During the first rehabilitation step, the patient was undergoing RASS-5, deep sedation, and mechanical ventilation; therefore, we were limited to passive range of motion exercises, prevention of ICU-AW and hypovolemia, autonomic adjustment for blood pressure maintenance, and sitting on the edge of the bed to promote expectoration (Figure 3). Next day onward, three sets of exercise were added; these included 50 steps, 20 half-squats, and 20 calf-raises (Figure 3).