Brainstem involvement and respiratory failure in COVID-19

Area of Science:

• Neurology
• Pulmonology
• Infectious Diseases

Background:

• Respiratory failure is a critical complication of COVID-19, often necessitating mechanical ventilation.
• The brainstem's role in severe COVID-19 respiratory failure has been hypothesized but not extensively studied.

Purpose of the Study:

• To investigate the potential involvement of the brainstem in persistent respiratory failure and weaning difficulties in COVID-19 patients.

Main Methods:

• Clinical evaluation of three intensive care unit (ICU) patients with COVID-19 who experienced weaning failure despite pneumonia recovery.
• Assessment focused on neurological signs suggestive of brainstem dysfunction, particularly affecting the respiratory center.

Main Results:

• Patients exhibited weaning failure from mechanical ventilation despite apparent recovery from lung involvement.
• Clinical assessments indicated potential brainstem dysfunction, specifically impacting the central respiratory drive.

Conclusions:

• Brainstem involvement may contribute to respiratory failure and mortality in COVID-19.
• Central respiratory drive depression could explain prolonged mechanical ventilation and extended ICU stays in some COVID-19 survivors.