Severely ill COVID-19 patients on ventilators are put in a prone position (face down) because it makes it easier for them to breathe and lowers death rates.
However, a recent study reveals that the life-saving position can also cause permanent nerve damage in these vulnerable patients.
According to a research published in the British Journal of Anaesthesia, nerve damage is caused by decreased blood flow and inflammation. Most non-COVID-19 patients on ventilators in this position seldom suffer nerve damage.
“This is a much higher percentage of patients with nerve damage than we’ve ever seen in any other critically ill population,” said study author Colin Franz from Northwestern University in the US.
“Ordinarily, very sick people can tolerate the position that helps their breathing. But COVID-19 patients’ nerves can’t tolerate the forces other people can generally bear,” Franz added.
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Based on this analysis, 12 to 15% of the most critically ill COVID-19 patients have permanent nerve damage. Based on the number of COVID patients worldwide, Franz has estimated that thousands of patients have been affected.
The paper points out that the injury has been missed because people who have been critically ill are expected to wake up with some generalized, symmetric weakness because they have been bedridden.
The weakness pattern in COVID-19 patients caught the attention of the researchers during rehabilitation, as a significant joint, such as the shoulder, ankle or wrist, would often be completely paralyzed on one side of the body.
The researchers said that they have noticed that patients are getting a lot of pressure at the elbow or at the neck. Due to this they have made some adjustments to the way they position the joints as well as put extra padding under the elbow and the knee where most pressure is experienced by the patient.
Wrist drops, foot drops, loss of hand control and frozen shoulder are the most common injuries. Some patients have as many as four different nerve injury sites. Some people who are dragging their feet require help with walking such as a cane, a brace or a wheelchair.
Mr Franz said that this could mean permanent difficulties with walking or critical hand functions like operating a computer or cell phone or writing.