Permanent Nerve Damage for Some COVID-19 Survivors
But he and his colleagues suspect that something about COVID-19 infection makes nerves more vulnerable to damage. Among the possible triggers: the increased inflammatory state caused by SARS-CoV-2, the virus responsible for COVID-19, as well as poor blood circulation and blood clotting.
Belly-triggered PNI can also result from “the way patients are positioned and the weight it can put on certain nerves for long periods of time,” said Dr Armeen Poor, attending physician in critical pulmonary medicine at the Metropolitan Hospital Center in New York City, which reviewed the results.
Another possible contributor: overworked hospital staff.
At the height of the pandemic, Poor said, “many hospitals were pronouncing more patients at a time than usual. This undue pressure on staff could have compromised the frequency of careful repositioning of patients in the supine position, and potentially increased the risk of nerve damage. “
Dr. Nicholas Caputo, deputy chief and emergency physician at Lincoln Medical and Mental Health Center, Bronx, NY, also reviewed the results. He said it’s important to recognize that this study only focused on patients pronounced on ventilators.
But, he noted, proning has been deployed successfully in unventilated patients, often in the hope of avoiding ventilation. These “self-pronounced” patients are awake and “instructed to change position if they become uncomfortable”.
In the intensive care unit, however, ventilated patients are typically spoken for eight to 12 hours before being returned, Caputo said. “It puts a lot more pressure on certain areas of the body and exposes patients to complications such as peripheral neuropathies,” he added.
In the hope of reducing the risk of constraint-related PNI in intubated patients, Franz’s team “mapped” the areas most vulnerable to nerve damage. This information could help doctors, nurses and physiotherapists deploy altered positioning, additional padding and protection of vulnerable areas. Portable sensors could be used to “measure and monitor [the] load of nerves, ”he said.
“In medicine, we focus on the ‘ABCs’ – airways, breathing and circulation – in an emergency,” Franz said. “Intubation and pronation positioning fall into these categories and save lives. It is always the first priority. We believe these additional measures will help prevent this nerve damage, however.”
The results have not yet been peer reviewed, but were published online recently in medRxiv before publication in The British Journal of Anesthesia.
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SOURCES: Colin Franz, MD, PhD, assistant professor, physical medicine and rehabilitation, and director of neurology, Regenerative Neurorehabilitation Laboratory, Feinberg School of Medicine at Northwestern University, Chicago; Nicholas Caputo, MD, MSc, assistant chief and attending physician, Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY, and Associate Professor, Clinical Emergency Medicine, Weill Cornell Medicine, New York City; Armeen Poor, MD, attending physician, pulmonary critical care medicine, Metropolitan Hospital Center, New York, and assistant professor, medicine, New York Medical College, New York City;The British Journal of Anesthesia, September 2020, online
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