PRONED VENTILATION AND ITS POSSIBLE ASSOCIATION WITH DROP FOOT

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The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causing the coronavirus disease 2019 (COVID-19) pandemic is known to lead to the complicated sequelae of severe acute respiratory distress syndrome which require ventilation. Proning has been used as a treatment to improve oxygenation in both ventilated and non-ventilated patients. This strategy has proven to be effective however complications have begun to arise. It is hypothesized that COVID-19 intensive care unit (ICU) proned ventilation is associated with new cases of foot drops or compressive unilateral ankle dorsiflexion weakness during the early 2020 COVID-19 pandemic. Proning is maintained with body positions alternated on an average of every 2-4 hours for 16-18 hours prone in either the swimmer’s position or other positions where the limbs are adjusted to avoid common pressure points. Five patients presented to an acute rehabilitation facility with unilateral ankle dorsiflexion weakness after ICU proned ventilation during the COVID-19 pandemic Compressive unilateral common peroneal neuropathies during the pandemic are possibly related to the impromptu, unconventional, and unfamiliar use of proned ventilation.

Compressive neuropathies associated with mechanical ventilation in prone positioning are rarely cited in the literature. Some risk factors for neuropathies include severe weight loss, diabetes mellitus, habitual leg crossing, compressive masses, and fibrous bands. 

It is possible that all patients with unilateral ankle dorsiflexion weakness developed them during the early 2020 COVID-19 pandemic with proned ventilation. The overwhelming hospital surge created a widespread lack of healthcare providers to turn patients in a timely manner. This quick impromptu implementation of an uncommonly and unfamiliarly used proned protocol possibly resulted in pressure-related injuries. Healthcare providers’ fears of entering the room frequently to change positions due to severe lack of personal protective equipment and uncertainty of viral infectivity while in the room may have been other factors contributing to poor adherence to the proning protocol, and thus, prolonged compressive neuropathy.

Chang L G, Zar S, Seidel B, et al. (April 08, 2021) COVID-19 Proned Ventilation and Its Possible Association With Foot Drop: A Case Series. Cureus 13(4): e14374. doi:10.7759/cureus.14374

Courtesy of Barry Block, editor of PM News


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