A thoracic specialist physiotherapist’s reflection of redeployment during the COVID-19 pandemic Michelle Gibb

The COVID-19 pandemic has been an overwhelming and exhausting time for all who work within the NHS presenting challenges and stresses never seen before. Many staff were redeployed into an unfamiliar and the unknown world of COVID-19, including myself.

I am a clinical specialist physiotherapist who has worked on our busy thoracic surgery unit in Leicester for the last five years and prior to this have worked in respiratory wards and ITU’s. In April 2020 I was redeployed into our adult iTU as the number of critically ill COVID-19 patients increased with us spilling out into three clinical ITU areas including our theatre recovery which brought our thoracic operating to a halt.

Initially critically unwell COVID-19 patients were the unknown, the early reports from colleagues in other countries were that patients presented as serve ARDS with high oxygenation needs but a low secretion load and were not requiring intensive airway clearance, in these early stages patients were not ready for rehabilitation. At this point many of my colleagues from other specialist areas of physiotherapy had been redeployed to work with us on intensive care and the respiratory wards.

We began to see a change in the need for physiotherapy. Patients after being unproned had larger secretion loads often with thick and difficult to clear secretions, this accompanied by patients having an absent cough requiring more intensive airway clearance whilst balancing interventions alongside the patients cardiovascular stability. Some of these interventions included percussions and shakes to a patient’s chest to loosen secretions, the use of nebulisation, manual assisted cough, and rehabilitation. This was all heavy work in full PPE. I quickly found that after a few hours working in a bay wearing full PPE it was time for a break.

I had mixed emotions throughout my time of redeployment into ITU. There were some very sad moments when patients lost their battle with this horrible virus and to see family members come in to say goodbye to their loved ones. To the highs and moments of success when patients began to make progress. A moment I will never forget is our first patient admitted to ITU with COVID-19, being ready to trial a speaking valve and hearing his voice for the first time and hearing him speak to his wife. All the successes were excellent motivation to keep going, I would often think about the thoracic patients having to wait for life saving surgery and how agonising that must have been for them and their families.

On reflection working clinically as a physiotherapist in COVID ITU challenged and progressed my rehabilitation with breathless and anxious patients with higher oxygen needs. These are factors that we see post-operatively in the thoracic population, but this was a new extreme and something I will adapt into my clinical practice for years to come. As COVID-19 numbers in ITU began to settle I went back my home to the thoracic surgery unit and surgeries began to resume. Unfortunately, as winter came around COVID numbers increased and myself and colleagues were redeployed once again to the ITU, this time for myself it was to another UHL hospital to aid with senior physiotherapy support. This time around we knew more of what we were dealing with, but everyone was tired and overwhelmed by COVID.

For myself, this time around some of the more specialist ITU physiotherapy skills were more at the forefront of my mind, working with the MDT on weaning plans, tracheostomy decanulation and planning rehabilitation. Some of my personal challenges at this time were working on an unfamiliar site, I was lucky to be surrounded by a fantastic team. During this wave of COVID, thoracic surgery was heavily reduced but continued, it was hard to be away from my specialist area of work and to be providing telephone support to the physiotherapists covering and to those who I would usually supervise. At this time, I also had two students start their 6-week placement. Within our trust physiotherapy student placements were stopped during the first wave and had commenced again. I think it was a challenging environment for both the students to be introduced into but also an excellent insight into the NHS during the pandemic, and with the prospect of COVID-19 not disappearing anytime soon, hopefully shaping the students’ knowledge and skills for the future.

Balancing all these factors and treating some of the most critically unwell patients was physically and emotionally draining. This time around patients were making excellent progress and then would deteriorate suddenly leading to re-intubation, patients requiring sedation and more ventilation and being unable to wean from ventilators or sadly passed away. There were again fantastic highs when patients improved and this made every effort worthwhile, but it was tough. For physiotherapy we were an integral part of the MDT working, leading on weaning plans, rehabilitation, and newer skills of implementing an extubation check list. During the first wave of the pandemic our ITU intensivists and MDT observed post extubation laryngeal odema increased leading to re-intubation. It was brilliant to be seeing my profession and my colleagues at the forefront of patient care during the pandemic and building on the physiotherapist’s role.

Since coming back from redeployment some of my personal reflections include being grateful for a sense of normality and to be back working with the thoracic MDT and patients. One of my personal observations is that the thoracic surgery patients appear more deconditioned and frailer, this group of patients has unfortunately had delayed surgery and have followed advice to shield at home and this has often led to increase inactivity and loss of fitness. I believe that in thoracic surgery, now more than ever, enhanced recovery is imperative to ensure our patients are as well as they can be prior to, during and after surgery. I hope that by sharing some of my own reflections it highlights and raises awareness of a role that physiotherapists have had during the pandemic. n

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REFERENCES: 1. Eto M et al. Elastomeric surgical sealant for hemostasis of cardiovascular anastomosis under full heparinization.

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