Prone positioning saves lives, but nerve pressure injury causes the hands and feet to deteriorate.
Seriously ill COVID-19 Patients are placed on a ventilator in a prone (under the face) position because it is easier for them to breathe and reduces mortality. But life-saving conditions can also cause permanent nerve damage in these debilitated patients, reports a newly accepted study from Shirley Ryan Abelis and Northwestern University Feinberg School of Medicine.
Scientists believe that nerve damage is the result of reduced blood flow and inflammation. Other non-COVID-19 patients on the ventilator in this condition rarely experience any nerve damage.
Accepted by study British Journal of Anesthesia. This can be seen as a preference.
“It’s shocking how big a problem this is,” lead investigator Drs. Said Colin Franz, Shirley Ryan is a physician-scientist at AbilityLab and an assistant professor of physical therapy and rehabilitation and neurology at Northwestern’s Phoenix School. “This is a much higher percentage of nerve damage patients than we’ve ever seen in any other seriously ill population. Typically, very ill people can tolerate a condition that helps their breathing. But COVID The veins of patients cannot tolerate the forces that other people can bear. ”
Based on this study and another one that followed Franz, 12% to 15% percent of the most seriously ill COVID-19 patients have permanent nerve damage. Based on the number of COVID patients worldwide, Franz estimates that thousands of patients have been affected.
“It’s our appreciation, if you take our numbers and remove them,” Franz said. So far, he and his colleagues have seen 20 patients from seven different hospitals with these injuries.
The injury has been recalled because severely ill people are expected to wake up with some generalized, symmetric weakness because they are bedrested, Franz said. But the pattern of weakness in COVID-19 patients caught the attention of researchers during rehabilitation because often an important joint organ such as the wrist, ankle, or shoulder is completely paralyzed from one side of the body.
As a result of the findings, physicians are modifying the positioning protocol prone to COVID-19 patients at Northwestern Memorial Hospital to prevent nerve damage.
“We noticed that patients are getting a lot of pressure on the elbow or neck, so we’ve made some adjustments to position the joints as well as applying additional padding below the elbow and knee where the most pressure is.” Franz said.
The most common injuries are wrist drops, foot drops, loss of hand function and frozen shoulder. Some patients had four different nerve injury sites. Some people who are stretching one leg require assistance with walking, such as a wheelchair, brace or cane.
Franz and co-workers are doing some therapeutic nerve stimulation, which has been shown to help replenish nerves in other tasks. Franz served as biomedical engineer John Rogers at Northwestern’s McCormick School of Engineering and an assistant professor of surgery at Feinberg and Dr. Northwestern Medicine plastic surgeon. Sumna collaborated with Jordan on this line of research.
But many patients have pre-existing conditions that interfere with nerve regeneration, such as diabetes mellitus, so they are less likely to recover their function.
“This means that there can be significant difficult tasks like moving or operating or operating a computer or cell phone,” Franz said.
Reference: George R. Malik, Alexis R. Wolfe, Rachana Soriano, Leslie Fiedberg, Lisa F. Wolfe, Swati Deshmukh, by “Injuries: Peripheral nerve injuries associated with a condition prone to COVID-19 related acute respiratory distress syndrome.” Jason H. Ko., Ryan P. Nussboom, Prakash Jaibalan, James M. Of Walter and Colin. Franz, accepted, British Journal of Anesthesia.
The multi-disciplinary team of scientists at Northwestern and Shirley Ryan AbilityLab are working on hot spots pressure maps for nerve sensitivity, radiology imaging for injury and skin sensors to help identify better “prone” positioning strategies for.