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      Current Challenges in the Management of Critically Ill COVID-19 Patients: The Effect of Critical Illness Myopathy

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          Abstract

          COVID-19 has proven to be one of the deadliestrespiratory diseases present in the world today. While many infections result in a mild, self-limiting illness, patients with severe disease often require high level critical care. Despite our best life saving measures, patients with COVID-19 who are admitted to intensive care units (ICUs) have a significantly higher mortality ratecompared to patients admitted to ICUs for other respiratory illnesses. This review of the literature aims to describe a pathophysiologic mechanism that we believe contributes to high mortality in severely ill COVID-19 patients. Critical illness myopathy and polyneuropathy (CIMPN) is a poorly understood disease process that contributes to muscle and nerve damage in critically ill patients. In CIMPN, excessive systemic inflammation and changes in blood composition lead to damage of nerves and vasculature, which results in weakening of musculature. Damage to respiratory muscles can further exacerbate poor blood oxygenation causedbylung inflammation. Many of the same inflammatory markers seen in SARS-CoV-2 infections have also been shown to contribute to CIMPN. Additionally, high blood sugar levels caused by the bodys stress response can also contribute to CIMPN. Based on our findings, we recommend that future studies of critically ill COVID-19 patients focus on suppressing the cytokine TGF-beta and controllingblood sugar levels in order to combat the effects of CIMPN.

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          Author and article information

          Journal
          ScienceOpen Preprints
          ScienceOpen
          9 January 2021
          Affiliations
          [1 ] School of Medicine, The University of Texas Medical Branch
          [2 ] Department of Orthopedic Surgery and Rehabilitation, The University of Texas Medical Branch
          Article
          10.14293/S2199-1006.1.SOR-.PPW3KYM.v1

          This work has been published open access under Creative Commons Attribution License CC BY 4.0 , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at www.scienceopen.com .

          Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

          Endocrinology & Diabetes, Emergency medicine & Trauma, Pathology, Immunology, Anatomy & Physiology, Molecular biology, Respiratory medicine, Infectious disease & Microbiology, Microbiology & Virology

          Respiratory therapy, Covid-19, Critical Illness Myopathy, Coronavirus, Inflammation, Glycemic control

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