Nerve Compression Injuries After Prolonged Prone Position Ventilation in Patients With SARS-CoV-2: A Case Series

Abstract

Background: Prone positioning improves oxygenation in adult respiratory distress syndrome. This procedure has been widely used during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. However, this procedure can also be responsible for nerve damage and plexopathy. Methods: We retrospectively reviewed a series of 7 infectious patients with coronavirus disease 2019 who underwent prone positioning ventilation at the San Raffaele Hospital of Milan, Italy, during the SARS-CoV-2 pandemic. Results: Clinical and neurophysiological data of 7 patients with nerve compression injuries have been reported. Conclusions: Health care workers should take into consideration the risk factors for prone positioningerelated plexopathy and nerve damage, especially in patients with coronavirus disease 2019, to prevent this type of complication.

Post-Extubation Dysphagia and Dysphonia amongst Adults with COVID-19 in the Republic of Ireland: a Prospective Multi-Site Observational Cohort Study

“…There was a threefold increase in impact on oral intake status with proning in this study. Lower cranial nerve paralysis and oropharyngeal oedema have previously been linked to proning, and cranial nerves IX to XII are hypothesised to be affected by proning (7,23). Pre-existing respiratory disease was also identified as a predictor of PED in this study.…”

“…Iatrogenic causes include prolonged intubation (5) and intubation injury including laryngeal oedema, granulations, ulceration and vocal cord immobility (6). Other potential factors are delirium (7), proning (8), disuse atrophy and critical illness neuropathy or myopathy during ICU stay (9) and neurological manifestations of COVID-19 (10). Also, tracheostomy insertion can lead to aspiration risk and difficulties managing secretions (3).…”

Post‐extubation dysphagia and dysphonia amongst adults with COVID‐19 in the Republic of Ireland: A prospective multi‐site observational cohort study

“…Over half of the participant group presented with dysphonia whereas 30% reported dysphagia, although 83% were on a normal diet. 7 Other potential factors contributing to PED are delirium, 8 proning, 6,9 disuse atrophy and critical illness neuropathy or myopathy during ICU stay 10 and neurological manifestations of COVID- 19. 11 Central and peripheral nervous system complications of COVID-19 include stroke, encephalitis and Guillain-Barre syndrome.…”

Doctor—Should I get the COVID‐19 vaccine? Infection and immunization in individuals with neuromuscular disorders

“…However, anti‐ganglioside antibodies have been only infrequently detected in reported cases of COVID‐19–associated GBS 26 . Other neuromuscular complications reported in COVID‐19 patients include myalgias and elevated CK levels, myositis, critical illness myopathy, mononeuritis multiplex, and entrapment neuropathies due to prolonged prone positioning 72‐79 . It remains uncertain whether these neuromuscular complications of COVID‐19 are due to direct viral invasion, an inflammatory/cytokine response to the virus, or to other factors.…”