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Anatomy, Physiology, and Dysfunction of the Diaphragm
Published in Massimo Zambon, Ultrasound of the Diaphragm and the Respiratory Muscles, 2022
The intensive care theatre is another setting in which diaphragmatic weakness occurs because of systemic conditions. In this setting, diaphragmatic hypotrophy ensues and is favoured by sepsis, multiorgan failure, hyperglycemia, muscle relaxants, and mechanical ventilation itself (even for brief periods). This is usually considered a consequence of critical-illness polyneuropathy and myopathy and has a multifactorial origin. In fact, besides simple diaphragmatic disuse, several conditions contribute to muscle atrophy hypophosphatemia, hypomagnesemia, hypokalemia, hypocalcemia, and thyroid disturbances. This issue is clinically prominent, since diaphragmatic hypotrophy prolongs ventilator dependency and its extent conditions the probability of weaning (47–49).
Multidisciplinary outpatient rehabilitation of physical and neurological sequelae and persistent symptoms of covid-19: a prospective, observational cohort study
Published in Disability and Rehabilitation, 2022
Sergiu Albu, Nicolás Rivas Zozaya, Narda Murillo, Alberto García-Molina, Cristian Andrés Figueroa Chacón, Hatice Kumru
Covid-19 is considered a respiratory infectious disease, with approximately 73% of patients presenting symptoms of pneumonia [1]. The clinical spectrum of acute COVID-19 infection, however, is very heterogeneous, with some patients developing neurological symptoms such as fatigue and myalgia, headache, anosmia and ageusia, dizziness, seizures, alterations in cognition and consciousness [2,3]. In addition, a relevant proportion of patients develop psychiatric symptoms such as anxiety, depression, sleep disturbances, phobias, and somatization, which are likely multifactorial due to psychological impacts of restrictions and epidemiologic measures, pre-existing mental health conditions, and financial and job insecurity [3]. As a result of direct neuronal invasion following SARS-CoV-2 infection, some patients experience neurological complications such as encephalopathy, encephalitis, acute cerebrovascular disease and Guillain-Barré syndrome or from secondary systemic complications or side effects of drug treatment [3,4]. Similarly, critical illness myopathy (CIM) and critical illness polyneuropathy (CIP) were reported in severe patients who required long intensive care unit (ICU) treatment [5,6].
Potential neurological manifestations of COVID-19: a narrative review
Published in Postgraduate Medicine, 2022
Joseph V. Pergolizzi, Robert B. Raffa, Giustino Varrassi, Peter Magnusson, Jo Ann LeQuang, Antonella Paladini, Robert Taylor, Charles Wollmuth, Frank Breve, Maninder Chopra, Rohit Nalamasu, Paul J. Christo
The literature reports a fatal case of a 34-year-old woman with diabetes hospitalized for MERS, who two weeks after diagnosis developed a headache with nausea and vomiting [15]. An urgent computed tomography scan showed right frontal lobe intracerebral hemorrhage with massive brain edema; laboratory findings showed disseminated intravascular coagulation, including thrombocytopenia and a prolonged coagulation profile. In another case, a 28-year-old man was hospitalized in the intensive care unit for MERS complicated by bacterial pneumonia and had to be put on a ventilator for respiratory distress. Unfortunately, after initial improvement, he reported weakness and tingling in his legs that made it impossible for him to walk. Using neuroimaging scans, cerebrospinal fluid analysis, nerve conduction velocity studies, and spinal imaging, a diagnosis was made of critical-illness polyneuropathy. He was treated with intravenous (IV) immunoglobulin 400 mg/kg daily for five days and was discharged in 40 days; gradual improvement was noted over the next 6 months [15].
Rehabilitation of patients with COVID-19
Published in Expert Review of Respiratory Medicine, 2020
Tiantian Sun, Liyun Guo, Fei Tian, Tiantian Dai, Xiaohong Xing, Junqing Zhao, Qiang Li
One study found that nearly 50% of patients admitted to the ICU with ARDS had associated critical illness polyneuropathy, of whom 48%–96% had critical illness myopathy, resulting in ICU-acquired weakness [61]. Ventilator use, long-term bed rest, and serious illness even post-treatment have been reported to result in patients experiencing pain, paralysis, urinary incontinence, anxiety, depression, post-traumatic stress disorder (PTSD), and cognitive impairment [57,62,63]. Neufeld et al. followed up 711 discharged patients post-ARDS treatment and found that most patients experienced severe fatigue and psychological and cognitive disorders and that the effect of these changes on their lives was much greater than their own physical dysfunction [64,65]. In patients who had undergone MV for >48 hours, 65% were reported to have had physical dysfunction after 1 year, 75% had cognitive impairment post-discharge, and 25% had severe mental illness [45,46]. Timely rehabilitation intervention can reduce or even eliminate the occurrence of these complications and the negative effects on patients’ everyday life [57,66,68].