Nerve Compression Injuries After Prolonged Prone Position Ventilation in Patients With SARS-CoV-2: A Case Series

Luigia Brugliera; Massimo Filippi; Ubaldo Del Carro; Calogera Butera; Francesca Bianchi; Paola Castellazzi; Paolo Cimino; Paolo Capodaglio; Giacomo Monti; Pietro Mortini; Luca G Pradotto; Lorenzo Priano; Alfio Spina; Sandro Iannaccone

doi:10.1016/j.apmr.2020.10.131

Nerve Compression Injuries After Prolonged Prone Position Ventilation in Patients With SARS-CoV-2: A Case Series

Arch Phys Med Rehabil. 2021 Mar;102(3):359-362. doi: 10.1016/j.apmr.2020.10.131. Epub 2020 Nov 25.

Authors

Affiliations

¹ Department of Rehabilitation and Functional Recovery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan. Electronic address: [email protected].
² Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Neurology Unit, Neurophysiology Unit, I.R.C.C.S. San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan.
³ Neurophysiology Unit, I.R.C.C.S. San Raffaele Scientific Institute, Milan.
⁴ Department of Rehabilitation and Functional Recovery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan.
⁵ Rehabilitation Unit, I.R.C.C.S. Istituto Auxologico Italiano, Piancavallo.
⁶ Department of Anaesthesia and Intensive Care, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan.
⁷ Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan.
⁸ Neurology Unit, I.R.C.C.S. Istituto Auxologico Italiano, Piancavallo, Italy; Department of Neuroscience, University of Torino, Turin, Italy.

Abstract

Background: Prone positioning improves oxygenation in adult respiratory distress syndrome. This procedure has been widely used during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. However, this procedure can also be responsible for nerve damage and plexopathy.

Methods: We retrospectively reviewed a series of 7 infectious patients with coronavirus disease 2019 who underwent prone positioning ventilation at the San Raffaele Hospital of Milan, Italy, during the SARS-CoV-2 pandemic.

Results: Clinical and neurophysiological data of 7 patients with nerve compression injuries have been reported.

Conclusions: Health care workers should take into consideration the risk factors for prone positioning-related plexopathy and nerve damage, especially in patients with coronavirus disease 2019, to prevent this type of complication.

Keywords: Brachial plexus; Coronavirus; Prone position; Rehabilitation.

MeSH terms

Adult
Aged
COVID-19 / physiopathology
COVID-19 / therapy*
Humans
Italy
Male
Middle Aged
Nerve Compression Syndromes / etiology*
Patient Positioning / adverse effects*
Prone Position*
Respiration, Artificial / adverse effects*
Retrospective Studies
SARS-CoV-2