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Monitoring and evaluation of muscle atrophy: a much needed step in critically ill COVID-19 patients

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Kumar A., Kumar A., Kumar N., Kumar A., Sinha C., Kumari P., Singh V.

Critical Care Innovations

2021

vol. 4

issue 1

30-43

INTRODUCTION: Elderly COVID-19 patients admitted to the intensive care unit (ICU) are at high risk of an inflammatory syndrome, hypercatabolic reaction, malnutrition, and physical immobilization. This may result in loss of muscle mass and pulmonary infection leading to prolonged ventilatory support. Factors responsible for muscle mass loss in ICU are (1) microcirculatory disturbances, (2) presence of systemic inflammatory response syndrome (SIRS), (3) sepsis (4) drugs (corticoids, neuromuscular blockers) having inhibitory activity on the nervous system, neuromuscular junction and muscle itself. Mechanism of muscle atrophy in critically ill elderly patients include an imbalance between protein synthesis and degradation. Interventions to manage muscle atrophy for the patients admitted to ICU is also extrapolated to mechanically ventilated COVID-ARDS patients. PURPOSE: Early recognition of factors contributing to intensive care unit acquired weakness (ICUAW) in COVID-19 patients, inflammation, high catabolic phase, steroid use, and paralysis. The potential interventions to target these specific mechanisms and ameliorate muscle dysfunction in COVID-19 patients. CONCLUSIONS:Intensive care unit acquired weakness (ICUAW) in critically ill COVID-19 patients is due to severity of illness, co-morbidities, muscle unloading, or ICU treatments, a systemic reaction circulating within the body, or combinations therein. Furthermore, the availability of a culture model of ICUAW could facilitate in expediting the diagnosis of ICUAW and fast track the discovery of putative treatments. We recommend NIV or HFNC ventilation or early weaning from invasive mechanical ventilation in critically ill COVID-19 elderly patients.

COVID-19 patients in myasthenic crisis managed successfully with noninvasive positive pressure ventilation: a case series.

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Mustahsin M., Choubey S., Malhotra V.

Critical Care Innovations

2021

vol. 4

issue 3

27-32

The management of respiratory failure during the present pandemic has been a challenging issue for the intensivists. There have been few case series and case reports on myasthenic crisis precipitated by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The combination of coronavirus disease-19 (COVID-19) pneumonia and myasthenic crisis can result in increased morbidity and mortality if not managed efficiently. The choice of ventilation ranges from non-invasive to invasive. However a lack of proper understanding of pathophysiology of myasthenia gravis and also the COVID-19 could make the decision of selecting the modality of ventilation a real difficult one. Although invasive ventilation is traditionally indicated when the myasthenia gravis patient presents in myasthenic crisis, there is emerging evidence for use of non-invasive ventilation with BiPAP mode in these patients. We present two cases of myasthenic crisis precipitated by SARS-CoV-2 which were successfully managed on non-invasive ventilation, thereby avoiding intubation and complications of invasive mechanical ventilation.

Postępowanie w przypadku niewydolności oddechowej podczas obecnej pandemii stanowiło wyzwanie dla intensywistów. Istnieje kilka serii przypadków i opisów przypadków dotyczących przełomu miastenicznego wywołanego ciężkim ostrym stanem zapalnym u zakażonych koronawirusem (SARS-CoV-2). Połączenie choroby koronawirusowej (COVID-19) z zapaleniem płuc i kryzysem miastenicznym może skutkować zwiększoną zachorowalnością i śmiertelnością, jeśli nie wdroży się skutecznego leczenia. Wybór wentylacji waha się od nieinwazyjnej do inwazyjnej. Jednak brak właściwego zrozumienia patofizjologii myasthenia gravis, a także COVID-19 może sprawić, że decyzja o wyborze sposobu wentylacji będzie naprawdę trudna. Chociaż wentylacja inwazyjna jest tradycyjnie wskazana, gdy pacjent z myasthenia gravis zgłasza się w kryzysie miastenicznym, to pojawiają się dowody przemawiające za stosowaniem wówczas nieinwazyjnej wentylacji w trybie BiPAP u tych pacjentów. Prezentujemy dwa przypadki przełomu miastenicznego wywołanego przez SARS-CoV-2, które z powodzeniem leczono metodą nieinwazyjną wentylacji, co pozwala uniknąć intubacji i powikłań inwazyjnej wentylacji mechanicznej.

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2 Critical Care Innovations

2 2021

1 Choubey S.

1 Kumar A.

1 Kumar N.

1 Kumari P.

1 Malhotra V.

1 Mustahsin M.

1 Singh V.

1 Sinha C.

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Monitoring and evaluation of muscle atrophy: a much needed step in critically ill COVID-19 patients

COVID-19 patients in myasthenic crisis managed successfully with noninvasive positive pressure ventilation: a case series.