Brachial plexus injury and facial breakdown as a consequence of proning during COVID-19 treatment

Ayala, Kelly; Redding, Jill; Lynch, Whitney; MacKinney, Theodore

ABSTRACT: By early 2020, the novel SARS-CoV-2 virus (COVID-19) was spreading rapidly worldwide, and its effects proved devastating. In many critically ill patients afflicted with COVID-19, treatment often involves prolonged periods of proning that, along with other interventions, can lead to improved oxygenation. However, sustaining this position predisposed patients to increased complications. We present a case of an older patient with respiratory failure secondary to COVID-19 who developed rapidly forming facial and knee wounds and a brachial plexus injury from proning. The pressure injuries were unresponsive to standard wound care treatments and resulted in full-thickness wounds. During outpatient posthospital follow-up, a facial eschar was debrided, and weakness of the left shoulder and arm secondary to a brachial plexus injury was identified. This case highlights various complications associated with prolonged proning and the importance of close attention to follow-up by both inpatient and outpatient providers.