Pressure Injury as Insidious Comorbidity in Ventilator-Dependent Respiratory Failure (VDRF) Secondary to COVID-19: A Case Report

Abstract

Research ObjectivesTo highlight opportunities to decrease adverse outcomes in the acute management of COVID-19 infection.DesignDescriptive single-subject study.SettingInpatient/Acute rehabilitation.ParticipantsA 47-year-old female with Ventilator-Dependent Respiratory Failure (VDRF) secondary to COVID-19.InterventionsIn the ED, Patient was started on antibiotics (azithromycin, ceftriaxone), nebulizer treatments, intravenous fluids, and intramuscular corticosteroids (methylprednisolone).On hospital admission, she was initiated on antiviral Remdesivir and received 1 unit of convalescent plasma. Self-proning was encouraged, yet Patient required progressive increase in oxygen (O2) supplementation. She was intubated from Hospital Day (HD) 4 to 7. Wound care assessments began on HD10; wounds to low back and bilateral buttocks were noted. By HD15, O2 requirements were further weaned and Patient was transferred to Acute Inpatient Rehab.On Rehab admission, Patient had Leukocytosis and wounds noted as “Unstageable”. Antibiotic coverage was increased (Cefepime). By HD28/ Rehab Day (RD) 13, wound culture was positive, and antibiotic regimen was further supplemented (Metronidazole, Fluconazole, Daptomycin).MRI thoracic spine and pelvis demonstrated “necrotizing soft-tissue infection”. Surgical debridement occurred HD31/RD16 with subsequent anemia, requiring transfusion. She underwent additional surgical debridement on HD38/RD23 and was returned to the Acute floors. She was discharged to home with outpatient wound care on HD53.Main Outcome MeasuresWound size (area).ResultsWound size: Hospital Day (HD) 10: 284.39cm2; HD16/Rehab Day (RD) 1: 698.6cm2; HD34/RD19: 265.66; HD39:747.72cm2; HD51: Area = 992.80cm2.∆Area, Pre-Rehab (HD16-HD10): (+) 414.2cm2; ∆Area, Rehab (HD34/RD19-HD16/RD1): (-) 439.94; ∆Area, Post-Rehab (HD51-HD34): (+) 727.14.ConclusionsInpatient Rehabilitation practices may help ameliorate pressure injury in cases of VDRF secondary to COVID-19 infection. Further study is warranted on the potential integration of such practices in this patient population, as a preventative measure in the Acute and/or Critical care settings.Author(s) DisclosuresAffiliation: HCA Healthcare (MountainView Hospital)Disclaimer: This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the authors and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.