ABSTRACT
It is known that there can be neurologic complications related to acute infection with SARS-CoV-2, the virus that causes COVID-19. Currently, there is a growing body of evidence that postacute sequelae of SARS-CoV-2 infection can manifest as neurologic sequelae as a result of direct neuroinvasion, autoimmunity, and possibly lead to chronic neurodegenerative processes. Certain complications can be associated with worse prognosis, lower functional outcome, and higher mortality. This article provides an overview of the known pathophysiology, symptoms presentation, complications and treatment approaches of the post-acute neurologic and neuromuscular sequelae of SARS-CoV-2 infection.
Subject(s)
COVID-19 , Nervous System Diseases , Humans , COVID-19/complications , SARS-CoV-2 , Nervous System Diseases/etiology , PrognosisABSTRACT
In COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO), our primary objective was to determine the frequency of intracranial hemorrhage (ICH). Secondary objectives were to estimate the frequency of ischemic stroke, to explore association between higher anticoagulation targets and ICH, and to estimate the association between neurologic complications and in-hospital mortality. DATA SOURCES: We searched MEDLINE, Embase, PsycINFO, Cochrane, and MedRxiv databases from inception to March 15, 2022. STUDY SELECTION: We identified studies that described acute neurological complications in adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring ECMO. DATA EXTRACTION: Two authors independently performed study selection and data extraction. Studies with 95% or more of its patients on venovenous or venoarterial ECMO were pooled for meta-analysis, which was calculated using a random-effects model. DATA SYNTHESIS: Fifty-four studies (n = 3,347) were included in the systematic review. Venovenous ECMO was used in 97% of patients. Meta-analysis of ICH and ischemic stroke on venovenous ECMO included 18 and 11 studies, respectively. The frequency of ICH was 11% (95% CI, 8-15%), with intraparenchymal hemorrhage being the most common subtype (73%), while the frequency of ischemic strokes was 2% (95% CI, 1-3%). Higher anticoagulation targets were not associated with increased frequency of ICH (p = 0.06). In-hospital mortality was 37% (95% CI, 34-40%) and neurologic causes ranked as the third most common cause of death. The risk ratio of mortality in COVID-19 patients with neurologic complications on venovenous ECMO compared with patients without neurologic complications was 2.24 (95% CI, 1.46-3.46). There were insufficient studies for meta-analysis of COVID-19 patients on venoarterial ECMO. CONCLUSIONS: COVID-19 patients requiring venovenous ECMO have a high frequency of ICH, and the development of neurologic complications more than doubled the risk of death. Healthcare providers should be aware of these increased risks and maintain a high index of suspicion for ICH.
ABSTRACT
Purpose: A tele-rehabilitation service was implemented in a geriatric day hospital during the COVID-19 pandemic. We aim to assess the effect of physiotherapy tele-rehabilitation on enhancing service delivery and quality of patient care. Methods: 144 patients were recruited from a geriatric day hospital. They were provided with comprehensive assessment, individualised home exercise programme, advice and education, and continuous monitoring through telephone call, video call, and messaging. Assessments and interventions were conducted under safe condition and environment, with assistance from carers. Functional mobility and balance were measured using the Modified Functional Ambulation Classification (MFAC), Berg Balance Scale (BBS), Modified Rivermead Mobility Index, Timed Up and Go Test, and 6-Minute Walk Test. Reliability of the estimated MFAC (assessed by phone call or videotaping) was evaluated by comparing with the post-program MFAC (assessed by face-to-face session). Patient satisfaction and carer satisfaction were also assessed. Results: 114 patients completed the physiotherapy tele-rehabilitation programme and were evaluated within 14 weeks. Each patient received a mean of 4.9 sessions. The mean times for initial assessment and follow-up assessment were 36.7 minutes and 18.2 minutes, respectively. After the programme, patients had significant improvement in ambulatory status (MFAC: 4.94 vs 5.15, p<0.05), balance (Berg Balance Scale: 29.97 vs 32.37, p<0.05), functional mobility (Modified Rivermead Mobility Index: 28.12 vs 29.30, p<0.05), and walking endurance (6-Minute Walk Test: 135.09 m vs 155.29 m, p<0.05), and walking speed (Timed Up and Go Test: 44.95 minutes vs 40.31 minutes, p=0.14). The estimated MFAC and post-programme MFAC were comparable (5.27 vs 5.15, p=0.071). Therefore, estimation of MFAC using telephone call or videotaping during tele-rehabilitation was reliable in assessing ambulatory status. The patient satisfaction rate was 100%. Conclusion: The physiotherapy tele-rehabilitation programme is a feasible mode of service delivery. It is a convenient complementary service model to conventional physical training for enhancing quality of care.
ABSTRACT
OBJECTIVE: The aim of this study was to report the safety, efficacy, and early results of tracheostomy in patients with COVID-19 and determine whether differences exist between percutaneous and open methods. SUMMARY BACKGROUND DATA: Prolonged respiratory failure is common in symptomatic patients with COVID-19, the disease process caused by infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Tracheostomy, although posing potential risk to the operative team and other healthcare workers, may be beneficial for safe weaning of sedation and ventilator support. However, short- and long-term outcomes remain largely unknown. METHODS: A prospectively collected database of patients with COVID-19 undergoing tracheostomy at a major medical center in New York City between April 4 and April 30, 2020 was reviewed. The primary endpoint was need for continued mechanical ventilation. Secondary outcomes included complication rates, sedation weaning, and need for intensive care unit (ICU) level of care. Patient characteristics, perioperative conditions, and outcomes between percutaneous and open groups were analyzed. RESULTS: During the study period, 67 consecutive patients underwent tracheostomy, including 48 males and 19 females with a median age of 66 years [interquartile range (IQR) 52-72]. Two surgeons alternated techniques, with 35 tracheostomies performed percutaneously and 32 via an open approach. The median time from intubation to tracheostomy was 23 days (IQR 20-26). At a median follow-up of 26 days, 52 patients (78%) no longer required mechanical ventilation and 58 patients (87%) were off continuous sedation. Five patients (7.5%) died of systemic causes. There were 11 total complications (16%) in 10 patients, most of which involved minor bleeding. There were no significant differences in outcomes between percutaneous and open methods. CONCLUSIONS: Tracheostomy under apneic conditions by either percutaneous or open technique can be safely performed in patients with respiratory failure due to COVID-19. Tracheostomy facilitated weaning from continuous intravenous sedation and mechanical ventilation. Continued follow-up of these patients to ascertain long-term outcome data is ongoing.