Folgeschäden durch Beatmung in Bauchlage bei COVID-19 und ihre Relevanz für die Frührehabilitation – eine retrospektive Kohortenstudie

Zusammenfassung

Hintergrund Die Bauchlagerung („proning“) als Teil der Behandlungsstrategie bei Patient:innen mit Acute Respiratory Distress Syndrome (ARDS) hat durch die COVID-19-Pandemie massiv an Bedeutung gewonnen. Neben den positiven Effekten der BL sind Nebenwirkungen bekannt, insbesondere Druckulcera (DU) und periphere Nervenläsionen (pNL).

Methoden In dieser retrospektiven Kohortenstudie wurden COVID-19-ARDS-Patient:innen, die supportiv in BL therapiert und im Behandlungsverlauf auf die Frührehabilitation übernommen wurden, auf das Vorliegen von DU und pNL hin untersucht. Es wurden potenzielle Risikofaktoren für das Entstehen von DU und pNL und der Einfluss von DU und pNL auf den Rehabilitationserfolg explorativ analysiert.

Ergebnisse Insgesamt wurden 52 Patient:innen in die Studie eingeschlossen. Von ihnen boten 10 (19,2%) das klinische Bild einer pNL und 41 (78,8%) wiesen bei Übernahme Bauchlagerungs-typische ventrale DU auf. Patient:innen mit pNL hatten signifikant häufiger einen Diabetes mellitus als Vorerkrankung, für die Entstehung von DU gab es keine Risikofaktoren. Bei Übernahme waren Patient:innen mit pNL im Durchschnitt weniger mobil und weniger selbstständig als Patient:innen ohne pNL, während zum Zeitpunkt der Entlassung keine signifikanten Unterschiede in Mobilität und ADL-Fähigkeit mehr vorlagen. Patient:innen mit pNL benötigten signifikant mehr Hilfsmittel bei Entlassung. DU sind häufig, v. a. im Gesicht-/Halsbereich (56,1%).

Schlussfolgerungen Nebenwirkungen der Bauchlagerung wie DU und pNL sind zum Zeitpunkt der Übernahme in die Frührehabilitation häufig. Während die Mobilität zum Übernahmezeitpunkt durch das Vorliegen einer pNL deutlicher eingeschränkt ist, besteht dieser Unterschied nicht mehr zum Entlasszeitpunkt.

Abstract

Background Prone positioning is a therapy option for patients with Acute Respiratory Distress Syndrome. It has become more relevant and common during the COVID-19 pandemic. Among known side effects, pressure ulcers (PU) and peripheral nerve lesions (PNL) are the most relevant

Methods In this retrospective cohort study we investigated the prevalence of PU and PNLin COVID-19 patients, who had been treated with prone positioning and had later been referred to an acute rehabilitation unit. Potential determinants for the occurrence of PU and PNL were identified. Potential effects of PU and PNL on the functional outcome of patients after acute rehabilitation were assessed.

Results 52 patients were included in this study. 78.8% had typical ventral PU at the time of referral to the acute rehabilitation unit, 10% showed clinical features of PNL. Patients with PNL had diabetes as a preexisting condition more frequently than patients without. The occurrence of PU could not be correlated with any risk factor. On admission to acute rehabilitation patients with PNL were less mobile and less selfsufficent than patients without PNL, however on discharge there were no more differences in mobility and self-sufficency. Patients with PNL needed significantly more aids. PU are very common, mainly affecting the face and neck (56,1%).

Conclusion This study shows that complications of BL are common on admission to acute rehabilitation. While mobility is lower on admission of patients with PNL, no such difference can be seen on discharge. Overall, patients with proning sequae don’t seem to be impaired in their mobility and ADL performance beyond their time in acute rehabilitation.

Schlüsselwörter

Frührehabilitation - Bauchlagerung - COVID-19-ARDS - Druckulcus - periphere Nervenläsion

Key words

early rehabilitation - Prone Position - COVID-19-Acute-Respiratory Distress Syndrome - Pressure Ulcers - peripheral nerve lesions

Publication History

Received: 13 May 2022

Accepted: 28 June 2022

Article published online:
02 September 2022

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