Acute neuromuscular syndromes with respiratory failure during COVID-19 pandemic: Where we stand and challenges ahead. (July 2022)

• Record Type: Journal Article
• Authors: Galassi, Giuliana; Marchioni, Alessandro
• Is Part Of: Journal of clinical neuroscience. Volume 101(2022)
• Page Start: 264
• Page End: 275
• Publication Date: 2022-07
• Subjects: COVID-19 -- Acute respiratory distress syndrome -- Myasthenic crisis -- Guillain-Barré syndrome -- Idiopathic inflammatory myopathies -- Non-invasive ventilation -- Mechanical ventilation; ARDS Acute respiratory distress syndrome -- GBS Guillain Barre' syndrome -- NIV Non -invasive ventilation -- MV Mechanical ventilation -- MC Myasthenic crisis -- COVID-19 Coronavirus disease; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2022.03.048
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Respiratory failure in the course of SARS-COV-2 infection is a complex and pathophysiology has not yet fully understood. In the more severe form of COVID-19, the variable association between viral alveolitis and impaired pulmonary perfusion constitutes main mechanism underlying onset of hypoxemia in most cases. The immunological derangement triggered by virus-host interactions may promote development of acute neuromuscular diseases, or it can exacerbate already existing conditions, causing weakness of respiratory muscles and alveolar hypoventilation. Non-invasive monitoring of respiratory muscles is very challenging, but could be essential to diagnose onset of respiratory muscle dysfunction in patients with suspected or pre-existing neuromuscular disorders. Abstract: Coronavirus disease 2019 (COVID-19), a disease caused by the novel betacoronavirus SARS-COV-2, has become a global pandemic threat. SARS- COV-2 is structurally similar to SARS-COV, and both bind to the angiotensin-converting enzyme 2 (ACE2) receptor to enter human cells. While patients typically present with fever, shortness of breath, sore throat, and cough, in some cases neurologic manifestations occur due to both direct and indirect involvement of the nervous system. Case reports include anosmia, ageusia, central respiratory failure, stroke, acute necrotizing hemorrhagic encephalopathy, toxic-metabolic encephalopathy, headache, myalgia, myelitis, ataxia, and various neuropsychiatric manifestations. Some patients with COVID-19 may present with concurrent acute neuromuscular syndromes such as myasthenic crisis (MC), Guillain–Barré syndrome (GBS) and idiopathic inflammatory myopathies (IIM); these conditions coupled with respiratory failure could trigger a life-threatening condition. Here, we review the current state of knowledge on acute neuromuscular syndromes with respiratory failure related to COVID-19 infection in an attempt to clarify and to manage the muscle dysfunction overlapping SARS-COV-2 infection.