Resident Physician Mt. Sinai LIVINSTON, New Jersey, United States
Case Diagnosis: Neuropathy following prolonged intubation in setting of COVID PNA
Case Description: 40 year old man admitted to hospital in Queens NY, found to be COVID + whom ultimately developed Acute Hypoxemic Respiratory Failure requiring intubation and mechanical ventilation for one month. His course was complicated by pressure injury, dysphagia, and new left upper extremity neuropathy. He was extubated and discharged to an acute rehab hospital on NC. Rehab Course: He dramatically improved in functionality and was slowly down titrated from NC to room air.Of note, he continued to report left hand weakness, difficulty making a fist; along with tingling hyperesthesia in the thumb and index finger radiating to the elbow, rated 8/10 in severity. Symptoms improved with Gabapentin. Physical exam notable for: Decreased AROM and weakness in the 1st and 2nd digit of the Left hand. Decreased sensation to left lateral forearm and dorsal C5 distribution, palmar C5 distribution allodynia Decreased AROM of the left arm due to pain and weakness
Discussions: Differential dx of the neuropathy includes compression nerve palsy leading to cervical radiculopathy, brachial plexus injury, median nerve injury, or critical illness myopathy. In anecdotal discussion with colleagues we have noted similar cases of neuropathy following prolonged ventilation.Thus, it is important to note the musculoskeletal complications which may occur after prolonged mechanical ventilation.
Conclusions: As the COVID pandemic continues to grip the nation; physiatrists will continue to play an important role in the recovery and rehabilitation of COVID patients. Appropriate limb positioning may prevent focal compression palsies as seen in this case (2) Physiatrists ought to assess for neuropathy as early as possible in ventilated patients. Early identification and rehabilitation of these neuropathies may lead to reduced health care costs and improved patient satisfaction.