Meralgia Paresthetica after Prone Positioning Ventilation in the Intensive Care Unit.

Christian Svendsen Juhl,Martin Ballegaard,Morten H Bestle,Peer Tfelt-Hansen

doi:10.1155/2016/7263201

Abstract

Meralgia paresthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) caused by external compression of the nerve during its course close to the anterior superior iliac spine. We present a case of a patient with acute respiratory distress induced by Legionella pneumonia who was admitted to the intensive care unit (ICU) for mechanical ventilation. In the ICU, the patient received one session of prone position ventilation for 8.5 consecutive hours. At evaluation six months later, the patient reported persistent bilateral numbness of the anterolateral thigh, which he complained had begun right after he woke up at the ICU. He was referred for further neurological and neurophysiological examination and was diagnosed with bilateral MP, a condition never previously described as a complication to mechanical ventilation in prone position in the ICU.

Highlights

Meralgia paresthetica (MP), or Bernhardt-Roth syndrome, is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN), resulting in hyposensitivity of the anterolateral thigh and sometimes neuropathic pain [1]
The iatrogenic form is, among others, seen as a complication to surgery with the patient placed in prone position but has, to our knowledge, never been described as a complication to mechanical ventilation in prone position in the intensive care unit (ICU) [3]
Prone positioning ventilation is frequently used in intensive care to improve blood oxygenation in patients with severe pneumonia and/or acute respiratory distress syndrome (ARDS) [4]

Summary

Introduction

Meralgia paresthetica (MP), or Bernhardt-Roth syndrome, is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN), resulting in hyposensitivity of the anterolateral thigh and sometimes neuropathic pain [1]. The condition is caused by compression of the LFCN, either idiopathic or iatrogenic. The iatrogenic form is, among others, seen as a complication to surgery with the patient placed in prone position but has, to our knowledge, never been described as a complication to mechanical ventilation in prone position in the intensive care unit (ICU) [3]. Prone positioning ventilation is frequently used in intensive care to improve blood oxygenation in patients with severe pneumonia and/or acute respiratory distress syndrome (ARDS) [4]. We present a case of a patient who developed bilateral meralgia paresthetica after 8.5 hours of prone positioning ventilation in the ICU

Case Presentation

Findings

Discussion

Conclusion