Movilización temprana en pacientes con ventilación mecánica contagiados por COVID-19 Early mobilization in patients with mechanical ventilation infected by COVID-19

contagiados con COVID-19, desde la epidemiología hasta las características clínicas, y el desarrollo de tratamientos farmacológicos que mejoran la mortalidad y la recuperación. Conclusión: Es esencial un enfoque terapéutico integrado para mitigar los efectos adversos para la salud física y mental de la neumonía por COVID-19. Abstract Patients infected with COVID-19 disease who require mechanical ventilation have a high mortality and use of resources. The ability to predict and issue clinical criteria in which patients may require mechanical ventilation will allow greater acuity of targeted care and intervention to potentially mitigate deterioration of their physiology. Objective: To examine through the review of the scientific literature on early mobilization in patients with mechanical ventilation infected with COVID-19. Methodology: A bibliographical analysis of the literature in different scientific journals such as SCOPUS, WEB OF SCIENCE and PUBMED was conducted under a narrative, interpretive and conceptual synthesis approach. Therefore, key terms in English and Spanish were used, such as: infected with covid-19", mechanically ventilated patients", "critical care medicine", "mechanical ventilation". The bibliographic sources were established from 2019 to 2021. Results: The existence of medical, logistical and protection challenges for medical personnel to provide respiratory support in patients infected with COVID-19 is demonstrated, from epidemiology to clinical characteristics, and the development of pharmacological treatments that improve mortality and survival. Conclusion: An integrated therapeutic approach is essential to mitigate the adverse physical and mental health effects of COVID-19 pneumonia. of early mobilization in mechanically ventilated patients infected with COVID-19; To examine the scientific literature on the types of activities in early mobilization in mechanically ventilated patients infected with COVID-19. To expose a reliable basis for the possible choice of clinical experiences in the management of patients with COVID-19.


Introduction
In December 2019, a cluster of pneumonias caused by an unknown pathogen was first reported in Wuhan, a city within the central part of China, linked to a large market offering varied species of live seafood and wild animals. The pneumonia-causing agent was later identified as a new coronavirus and named severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (Rushforth et al., 2021).
Genetic analysis of whole genome sequences revealed that SARS-CoV-2 is most closely related to a bat coronavirus named Bat-CoV-RaTG13, explaining bats as the likely origin, which suggested the high possibility of animal-to-human transmission (Reyes et al., 2021;Rushforth et al., 2021). Subsequently, person-to-person transmission was confirmed in 15 health care professionals, all infected by a patient with the new coronavirus infection.
The identification of the pathogen and the transmission pattern have led to the implementation of high-level preventive and control measures by the Chinese government and the World Health Organization (WHO), which consequently declared coronavirus disease (COVID-19) a public health emergency of international concern (Reyes et al., 2021;Rushforth et al., 2021).
COVID-19 has now become a global pandemic that seriously endangers human health. Among patients with COVID-19, 31% of them progressed to ARDS (Acute Respiratory Distress Syndrome), and some cases were even complex by severe refractory development of ARDS to mechanical ventilation (MV) with an average mortality rate (Shima et al., 2020) .Due to the improved efficacy achieved by ECMO (Extracorporeal Membrane Oxygenation) during the H1N1 influenza crisis (Swine Flu) in 2009, it was successfully applied for the treatment of H7N9 (Avian Influenza A Virus) and SARS-CoV-2 (Tang et al., 2021). ISSN: 2600-5859 Vol. 5 No 3, pp. 85 -106 , julio-septiembre 2022 www.concienciadigital.org Studies of invasive mechanical ventilation to treat respiratory failure for COVID-19 have shown a mortality rate greater than 85%. Although limited information is available on which patients admitted to hospitals or clinics not requiring mechanical ventilation will progress to mechanical ventilation and what clinical factors are associated with such progression (Sasidharan et al., 2021).
Recent studies have shown that the mortality rate of patients with COVID-19 treated with ECMO remains high. At present, there are no case reports on successful treatment of COVID-19 patients complicated with ARDS by ECMO. However, there are clinical cases that were successfully treated by combining early MV with ECMO, providing experience for treatment in critically ill COVID-19 patients (Mellow et al., 2020;Zhong et al., 2020).
It should be taken into account that better identification of patients likely to require mechanical ventilation will allow closer monitoring of signs of clinical deterioration and optimize the allocation of resources such as ventilators and intensive care beds (Hill et al., 2020;Zhong et al., 2020). New analytical techniques could also reveal previously unrecognized indicators of a worsening respiratory trajectory. This could guide treatment decisions (e.g., medications such as anticoagulants or corticosteroids, tighter hemodynamic regulation, or supplemental oxygen titration) that may mitigate progression to respiratory failure (Zhong et al., 2020).
Therefore, this study lies in the purpose of exposing as main objective: To review in the scientific literature on early mobilization in mechanically ventilated patients infected by COVID-19.
At the same time, it explores the definitions and impact of the problematic that exists in the development of treatment strategies for early mechanical ventilation, performing a detailed analysis of the types of pathogens and risk factors, providing specific objectives oriented to; Contrast on the scientific evidence on the coronavirus (COVID-19) caused by the SARS-CoV-2 virus; To explore the definitions of early mobilization in mechanically ventilated patients infected with COVID-19; To examine the scientific literature on the types of activities in early mobilization in mechanically ventilated patients infected with COVID-19. To expose a reliable basis for the possible choice of clinical experiences in the management of patients with COVID-19.

Methodology
The type of research was based on the bibliographic analysis of the literature in different scientific journals under a narrative, interpretative, conceptual, and iterative synthesis approach that emphasized the importance of developing a critique based on the relevance, credibility, and contribution of the evidence rather than on methodological considerations ISSN: 2600-5859 Vol. 5 No 3, pp. 85 -106 , julio-septiembre 2022 www.concienciadigital.org rigidly determined in analysis and synthesis under the recommendations of the PRISMA statement.
In the literature search strategy, the SCOPUS, WEB OF SCIENCE and PUBMED databases were used as sources of bibliographic data oriented to this review of the exposed objectives. It should be noted that, publications were selected between the years 2019 to 2021, with the following descriptors in Spanish and English: "patients infected with covid-19", "covid-19", "infected mechanically ventilated patients", "critical care medicine", "mechanical ventilation", "predictive models respiratory", "respiratory insufficiency", "respiratory failure".
Likewise, in the third research phase, we present the respective inclusion criteria of the literature review, leading to the explicit collection of information from 1 year with the serious health crisis due to COVID-19 describing consequences and rehabilitation of patients, to present reliable and quality information.
It can be inferred that, explicitly, the exclusion criterion in the fourth research phase was strictly developed to reduce contradictory information or information not intrinsically related to the research topic.

Results and Discussion
A flow chart was designed based on the compilation of scientific articles where a literary research procedure is presented with the objective of selecting studies according to the relationship of the subject, based on the characteristics of the variables of interest such as: patients infected with COVID-19, COVID-19, mechanically ventilated infected patients, intensive care medicine, mechanical ventilation, respiratory predictive models, respiratory failure, respiratory failure.
In the studies collected, international studies were selected from the most prestigious journals and scientific databases for subsequent presentation of their literature. ISSN: 2600-5859 Vol. 5 No 3, pp. 85 -106 , julio-septiembre 2022 www.concienciadigital.org

Figure 1
The findings obtained in the present study were based on the analysis of the literature review in relation to early mobilization in mechanically ventilated patients infected with COVID-19, focusing on procedures, risks, criteria for treatment comparison, medical assistance, adequate pulmonary rehabilitation, and other pulmonary disorders.
For this reason, it was considered to expose studies of different research authors in relation to the topic of study.

Conclusions
 SARS-CoV-2 infection is a complex multi-organ disease with peculiar and specific characteristics that requires invasive individualized treatment, especially in mechanically ventilated patients in the ICU.  The mortality rate remains high among critically ill patients, although recent research has improved our understanding of the pathophysiology of COVID-19 and clarified the therapeutic role of specific medications and ventilation strategies, but questions remain about the optimal management of these patients.  In this context, it is important to better understand the pathophysiology of SARS-CoV-2 induced pneumonia and damage to other organs, such as the best time to intubate patients, parameters to assess at the bedside and the ability to mitigate patient self-assessment, inflicted lung injury and ventilator-induced lung injury, as well as how to establish proper personal protective equipment in both supine and prone positions, and how to avoid lung fibrosis and strengthen the muscles involved in breathing in mechanically ventilated patients.  Many questions are ongoing with the aim of clarifying not only mechanical ventilation strategies, but also new therapies such as immunomodulatory drugs, prolonged prone positioning for mechanically ventilated patients infected with COVID-19 (Parker et al., 2021).
nurses with similar practice patterns.
During COVID-19, augmentation patients were treated in intensive care units and hospital floors by caregivers who were often not trained in intensive care medicine.
Given the differences in treatment, these patients would not have been valid for inclusion either in focus groups that identified the knowledge, resources, and culture of the team to determine successful prone positioning procedures.