Abstract
A subgroup of COVID-19 patients requires intensive respiratory care. The prolonged immobilization and aggressive treatments predispose these patients to develop intensive care unit-acquired weakness (ICUAW). Furthermore, this condition could increase the chance of positioning-related peripheral nerve injuries. On the basis of the latest literature review, we describe a case series of three patients with COVID-19 who developed ICUAW complicated by positioning-related peripheral nerve injuries Every patient presented sensorimotor axonal polyneuropathy and concomitant myopathy in electrophysiological studies. Furthermore, muscle MRI helped the diagnosis of ICUAW, showing massive damage predominantly in the proximal muscles. Notably, nerve ultrasound detected positioning-related peripheral nerve injuries, even though the concomitant ICUAW substantially masked their clinical features. During the acute phase of severe COVID-19 infection, most medical attention tends to be assigned to critical care management, and neuromuscular complications such as ICUAW and positioning-related peripheral nerve injuries could be underestimated. Hence, when starting post-ICU care for COVID-19 cases, the combination of electrophysiological and imaging studies will aid appropriate evaluation on the patients with COVID-19-related ICUAW.
Highlights
Intensive care unit-acquired weakness (ICUAW) is an acquired neuromuscular disorder in critical patients characterized by generalized muscle weakness and failure to wean from the ventilator
It consists of three subtypes: critical illness polyneuropathy (CIP); critical illness myopathy (CIM); and critical illness neuromyopathy (CINM), a combined form of CIP and CIM [1,2]
We describe three COVID-19 patients with ICUAW complicated by peripheral nerve injury
Summary
Intensive care unit-acquired weakness (ICUAW) is an acquired neuromuscular disorder in critical patients characterized by generalized muscle weakness and failure to wean from the ventilator. While peripheral nerve injury is a known complication in general ICU care, COVID-19 patients may be more prone to this complication due to intensive respiratory management, including prolonged immobilization and prone positioning, leading to unexpected compression and stretching of the nerves [15,16,17,20]. After being weaned off from mechanical ventilation, the patient was transferred to our rehabilitation unit on day 75 He showed severe generalized muscle weakness (MRC sum score: 27/60) and marked dysesthesia and hypesthesia, predominantly in the distal legs.
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