COVID-19, SARS-CoV-2, respiratory insufficiency, mechanical ventilators, ventilator-induced lung injury
Rehabilitation and Therapy | Respiratory Therapy | Respiratory Tract Diseases | Virus Diseases
Research Objectives: To highlight opportunities to decrease adverse outcomes in the acute management of COVID-19 infection.
Design: Descriptive single-subject study
Setting: Inpatient/Acute rehabilitation
Participants: A 47-year-old female with Ventilator-Dependent Respiratory Failure (VDRF) secondary to COVID-19.
Interventions: In the ED, Patient was started on antibiotics (azithromycin, ceftriaxone), nebulizer treatments, intravenous fluids, and intramuscular corticosteroids (methylprednisolone).
On hospital admission, she was initiated on antiviral Remdesivir and received 1 unit of convalescent plasma. Self-proning was encouraged, yet Patient required progressive increase in oxygen (O2) supplementation. She was intubated from Hospital Day (HD) 4 to 7. Wound care assessments began on HD10; wounds to low back and bilateral buttocks were noted. By HD15, O2 requirements were further weaned and Patient was transferred to Acute Inpatient Rehab.
On Rehab admission, Patient had Leukocytosis and wounds noted as “Unstageable”. Antibiotic coverage was increased (Cefepime). By HD28/ Rehab Day (RD) 13, wound culture was positive, and antibiotic regimen was further supplemented (Metronidazole, Fluconazole, Daptomycin).
MRI thoracic spine and pelvis demonstrated “necrotizing soft-tissue infection”. Surgical debridement occurred HD31/RD16 with subsequent anemia, requiring transfusion. She underwent additional surgical debridement on HD38/RD23 and was returned to the Acute floors. She was discharged to home with outpatient wound care on HD53.
Main Outcome Measures: Wound size (area).
Results: Wound size: Hospital Day (HD) 10: 284.39cm2; HD16/Rehab Day (RD) 1: 698.6cm2; HD34/RD19: 265.66; HD39:747.72cm2; HD51: Area = 992.80cm2.
∆Area, Pre-Rehab (HD16-HD10): (+) 414.2cm2; ∆Area, Rehab (HD34/RD19-HD16/RD1): (-) 439.94; ∆Area, Post-Rehab (HD51-HD34): (+) 727.14.
Conclusions: Inpatient Rehabilitation practices may help ameliorate pressure injury in cases of VDRF secondary to COVID-19 infection. Further study is warranted on the potential integration of such practices in this patient population, as a preventative measure in the Acute and/or Critical care settings.
Publisher or Conference
American Congress of Rehabilitation Medicine Annual Conference
Rodriguez CA Jr., Doddy KR, Ayutyanont N. Pressure injury as insidious comorbidity in Ventilator-Dependent Respiratory Failure (VDRF) secondary to COVID-19: A Case Report. Presented at: ACRM 2021 Annual Meeting; September 27, 2021.
Available for download on Tuesday, September 27, 2022