The distribution of acquired peripheral nerve injuries associated with severe COVID-19 implicate a mechanism of entrapment neuropathy: a multicenter case series and clinical feasibility study of a wearable, wireless pressure sensor

Abstract

We diagnosed 66 peripheral nerve injuries in 34 patients who survived severe coronavirus disease 2019 (COVID-19). We combine this new data with published case series re-analyzed here (117 nerve injuries; 58 patients) to provide a comprehensive accounting of lesion sites. The most common are ulnar (25.1%), common fibular (15.8%), sciatic (13.1%), median (9.8%), brachial plexus (8.7%) and radial (8.2%) nerves at sites known to be vulnerable to mechanical loading. Protection of peripheral nerves should be prioritized in the care of COVID-19 patients. To this end, we report proof of concept data of the feasibility for a wearable, wireless pressure sensor to provide real time monitoring in the intensive care unit setting.

Keywords: Brachial plexus; COVID-19; Intensive care unit; Neuromuscular; Neuropathy; Peripheral nerve injury; Rehabilitation; Wearable sensor.

Fig. 1

Graphical summary of common nerve injury sites in survivors of COVID-19. This summary includes current data and several recent case series of peripheral nerve injuries associated with COVID-19. Inset photographs show examples skin pressure sores overlaying the nerve compression sites – elbow (top) and fibular head (bottom)

Fig. 2

Soft, skin-interfaced sensor for wireless measurements of pressure for COVID19 patients in ICU. A Functional block diagram of the system that is powered through a battery, illustrating a Bluetooth Low Energy (BLE) system-on-a-chip (SoC), which connects to a Wheatstone bridge (WB) and an instrumentation amplifier (Amp) that convert and amplify the signal of the pressure sensor. The analog-to-digital converter (ADC)-sampled data passes through the central processing unit (CPU), which then transmits to BLE radio, displaying real-time data on the graphical user interface (smartphone). B Photograph of the sensor, depicting its thin and flexible form factor. C Photograph of a subject’s elbow, wearing the Tegaderm-secured sensor at the medial epicondyle. G Illustration of an intubated subject with the left arm up, in a reverse Trendelenburg position with chest paddings. E Representative pressure data of the self-proning subject at both left and right arms. Colored regions indicate self-adjustments. F Pressure measured in demonstrated normal prone position on both arms (measured at 10 Hz for 200, 300 s, respectively, data with individual sensor; error bar: SD). D Photograph of a self-proning subject (i.e. patient rolls themselves over on belly), placing his arms with the sensors upward. Red-dashed rectangle shows the unloading of the arm. H Representative pressure data of an intubated subject in the demonstrated normal prone position and the adjusted/optimized position. I Pressure measured in demonstrated normal prone position and adjusted, optimized prone position (measured at 10 Hz for 60, 900 s, respectively, data with the same sensor; error bar: SD)