The distribution of acquired peripheral nerve injuries associated with severe COVID-19 implicate a mechanism of entrapment neuropathy: a multicenter case series and clinical feasibility study of a wearable, wireless pressure sensor

Franz, Colin K.; Murthy, Nikhil K.; Malik, George R.; Kwak, Jean Won; D’Andrea, Dom; Wolfe, Alexis R.; Farr, Ellen; Stearns, Melanie; Deshmukh, Swati; Tavee, Jinny; Sun, Fang; Swong, Kevin; Rydberg, Leslie; Cotton, R.; Wolfe, Lisa F.; Walter, James M.; Coleman, John M.; Li, Jinghua

doi:10.1186/s12984-022-01089-1

Cited by 14 publications

(23 citation statements)

References 24 publications

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“…Although other studies have used diaphragm ultrasound to characterize patients with severe COVID either acutely [2,18,19] or in outpatient follow up, [20] but little is known about diaphragm muscle structural changes in Long COVID especially in non-hospitalized patients that make up the majority of our current cohort (72%). Given the high rates of fatigue and dyspnea in people living with Long COVID, [6] this study contributes by identifying a structural abnormality (reduced diaphragm muscle thickness) that physical therapy can be speci cally designed to directly address (Figure 2C).…”

Section: Discussionmentioning

confidence: 99%

Sonographic Diaphragm Abnormalities are an Unexpectedly Frequent Feature of Long COVID Outpatients with Unexplained Dyspnea and Fatigue

Deo,

Bailey,

Jensen

et al. 2023

Preprint

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Purpose The primary aim of this study is to define the sonographic diaphragm phenotype of Long COVID rehabilitation outpatients with non-specific dyspnea and fatigue. We analyzed patients referred from a pulmonary post-COVID clinic that were lacking a specific cardiopulmonary diagnosis for their symptoms. Additionally, we report the functional outcomes of subset of patients who completed an outpatient cardiopulmonary physical therapy program.Methods This was a retrospective cohort study (n = 58) of consecutive patients referred for neuromuscular ultrasound assessment of diaphragm muscle using B-mode technique. Patients were recruited from a single academic hospital between February 25, 2021 and November 22, 2022.Results Sonographic abnormalities were identified in 57% (33/58) of patients, and in the vast majority of cases (33/33) was defined by a low diaphragm muscle thickness. Thinner diaphragm muscles are correlated with lower serum creatinine and creatine kinase values, but there was no association with markers of systemic inflammation. Thirty three patients participated in outpatient cardiopulmonary physical therapy that included respiratory muscle training, and 75.8% (25/33) had documented improvement.Conclusion In the outpatient rehabilitation setting, patients with Long COVID display low diaphragm muscle thickness, but intact muscle contractility, with surprising frequency on neuromuscular ultrasound. We speculate this represents a form of disuse atrophy. Also, these patients appear to have a favorable response to cardiopulmonary physical therapy that includes respiratory muscle training.

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Section: Discussionmentioning

confidence: 99%

Sonographic Diaphragm Abnormalities are an Unexpectedly Frequent Feature of Long COVID Outpatients with Unexplained Dyspnea and Fatigue

Deo,

Bailey,

Jensen

et al. 2023

Preprint

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“…In a mentioned study this sensor was used to monitor the area of the ulnar nerve. Obtained results provide to control the position and prevent nerve injuries (Franz et al, 2022). This issue requires further research, nevertheless this sensor might become an important device in the ICU, that will prevent a complication of the prone position.…”

Section: Discussionmentioning

confidence: 99%

Brachial plexopathy as a result of anatomical prone position in COVID‐19 patients—Systematic review

Toruńska,

Owczarek‐Konopka,

Konopka

et al. 2023

Clinical Anatomy

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In patients with COVID‐19 different methods improving therapy have been used, including one of the anatomical position–prone position, to support ventilation. The aim of this review was to summarize the cases of brachial plexopathy as a consequence of the prone position in COVID‐19 patients, and thus bring closer the issue of the brachial plexus in the face of clinical aspects of its function, palsy, and consequences. The Preferred Reporting Items for Systematic Reviews and Meta‐analyses statement was followed, inclusion criteria were created according to Patients, Interventions, Comparisons, Outcomes (PICO). PubMed and Scopus were searched until April 1, 2023 by entering the key term with Boolean terms. The risk of bias was assessed using JBI's critical appraisal tools. Fifteen papers with 30 patients were included in the review. This study showed that brachial plexopathy after the prone position occurs more often among males, who are at least 50 years old with comorbidities like hypertension, overweight, and diabetes mellitus. The most common symptoms were weakness, pain, and motion deficits. Duration of the prone position session and the number of episodes were different as well as the modification of positioning. Brachial plexopathy is a significant problem during prone position, especially when hospitalization is prolonged, patients are males, have comorbidities, and changes in body weight. Attention should be drawn to understand the anatomy of the brachial plexus, correct positioning, avoiding factors worsening the prognosis, and proper nutrition of the patients.

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“…Although other studies have used diaphragm ultrasound to characterize patients with severe COVID either acutely 2,20,21 or in outpatient follow up, 22 but little is known about diaphragm muscle structural changes in Long COVID especially in non-hospitalized patients that make up the majority of our current cohort (72%). Given the high rates of fatigue and dyspnea in people living with Long COVID 7 , this study contributes by identifying a structural abnormality (reduced diaphragm muscle thickness) that physical therapy can be specifically designed to directly address (Figure 2C).…”

Section: Discussionmentioning

confidence: 99%

Sonographic Diaphragm Abnormalities are an Unexpectedly Frequent Feature of Long COVID Outpatients with Unexplained Dyspnea and Fatigue

Deo

Bailey²,

Farr

et al. 2022

Preprint

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Introduction/Aims: The primary aim of this study is to define the sonographic diaphragm phenotype of Long COVID patients with non-specific dyspnea and fatigue. We analyzed patients referred from a pulmonary medicine COVID clinic without any intrinsic cardiopulmonary explanation for their new symptoms. Additionally, we report the functional outcomes of patients who completed an outpatient cardiopulmonary physical therapy program. Methods: This was a retrospective cohort study (n = 37) of consecutive patients referred for neuromuscular assessment centered on B-mode ultrasound of the diaphragm muscle. Patients were recruited from a single academic hospital between February 25, 2021 and October 7, 2021. Results: Sonographic abnormalities were identified in 65% (24/37) of patients, and in the vast majority of cases (23/24) was defined by low diaphragm muscle thickness. Thinner diaphragm muscles positively correlated with lower serum creatinine and creatine kinase values, but there was no association with markers of systemic inflammation. Eighteen patients participated in outpatient cardiopulmonary physical therapy that included respiratory muscle training, and 77.8% (n=14) had documented improvement. Discussion: In the outpatient rehabilitation setting, patients with Long COVID frequently display low diaphragm muscle thickness, but intact muscle contractility on sonographic studies. We speculate this represents a form of disuse atrophy, which has a good response rate to cardiopulmonary physical therapy.

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The distribution of acquired peripheral nerve injuries associated with severe COVID-19 implicate a mechanism of entrapment neuropathy: a multicenter case series and clinical feasibility study of a wearable, wireless pressure sensor

Cited by 14 publications

References 24 publications

Sonographic Diaphragm Abnormalities are an Unexpectedly Frequent Feature of Long COVID Outpatients with Unexplained Dyspnea and Fatigue

Sonographic Diaphragm Abnormalities are an Unexpectedly Frequent Feature of Long COVID Outpatients with Unexplained Dyspnea and Fatigue

Brachial plexopathy as a result of anatomical prone position in COVID‐19 patients—Systematic review

Sonographic Diaphragm Abnormalities are an Unexpectedly Frequent Feature of Long COVID Outpatients with Unexplained Dyspnea and Fatigue

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