Lessons from an ICU recovery clinic: two cases of meralgia paresthetica after prone positioning to treat COVID-19-associ
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RESEARCH LETTER
Open Access
Lessons from an ICU recovery clinic: two cases of meralgia paresthetica after prone positioning to treat COVID-19-associated ARDS and modification of unit practices Amy L. Bellinghausen1* , Jamie N. LaBuzetta2, Frank Chu3, Francesca Novelli4, Anthony R. Rodelo4 and Robert L. Owens1
Keywords: Meralgia paresthetica, Prone, COVID-19, Acute respiratory distress syndrome, ICU recovery clinic
Main text Prone positioning is one of the few interventions in acute respiratory distress syndrome (ARDS) which has a proven mortality reduction [1]. Due to the coronavirus disease 2019 (COVID-19) pandemic, severe ARDS cases have sharply increased worldwide, increasing the need for proning. Some centers have also encouraged non-intubated patients with hypoxemia due to COVID-19 to self-prone [2] Although generally considered low risk, pressure-related complications can occur during proning and differ from those that occur in supine patients. We present two cases of COVID-19-associated ARDS treated with prone positioning who developed meralgia paresthetica that was diagnosed in our ICU recovery clinic. Meralgia paresthetica (MP) results from compression injury of the lateral femoral cutaneous nerve between the anterior superior iliac spine and the inguinal ligament (Fig. 1); this mononeuropathy results in sensory abnormalities in the anterolateral thigh [3]. To our knowledge, there is only one other reported case of MP in prone positioning for ARDS, although it has been reported after surgical prone positioning in up to 24% of cases [4, 5]. The first patient was a 53-year-old man with diabetes (well-controlled, glycosylated hemoglobin 6.5 to 7.0%), obesity (BMI 30.9), and hypertension, who was mechanically * Correspondence: [email protected] 1 Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California San Diego, San Diego, CA, USA Full list of author information is available at the end of the article
ventilated for 11 days. He had a single session of proning for 16 h. He was extubated and discharged home on day 19 of admission. During his ICU recovery clinic visit (2 months after discharge), he reported isolated left-sided, welldemarcated anterior thigh numbness, new since his hospital stay. He had no associated weakness or pain, though did also endorse some non-painful numbness and tingling in
Fig. 1 Lateral femoral cutaneous nerve compression in the prone position. (A) Lateral femoral cutaneous nerve (cross-section). (B) Inguinal ligament. (C) Surface of the hospital bed
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