Tapia syndrome: an Unusual Complication to Recognize at the Time of the COVID-19 Pandemic

Author(s): Michaël Piagnerelli, Delphine Ranwez, Perrine Arnould, Chloe d’Adesky, Patrick Biston, Myriam Houa

Guidelines for acute respiratory distress syndrome (ARDS) management include sedation, neuromuscular blockade for protective ventilation and the need for the prone position. This technique can lead to neurologic sequelae like the Tapia syndrome following the patient position. We reported two ARDS COVD-19 patients with Tapia syndrome due to prone position. Both patients, a white European 57 year-old female and a Black African 50 year-old male, were intensive care unit (ICU) admitted for ARDS due to COVID-19. They were orotracheal intubated and mechanical ventilated for respectively 23 and 68 days with 7 and 4 sessions of prone position. Both were tracheotomized during their ICU stay. We observed during the respiratory weaning, swallowing difficulties associated with a tongue deviation during protusion and paralysis of the ipsilateral vocal cord suggesting a Tapia syndrome. Prone position for the treatment of hypoxic ARDS COVID-19 patients with lateral flexion of the head could induce a compression on the lower cranial nerves and their collateral branches and lead to the Tapia syndrome with long neurologic sequelae: swallowing disorder, dysarthria and dysphagia due to difficulty to move the tongue with paralysis of the vocal cord. Because mechanical ventilation on prone position is a cornerstone of the treatment of hypoxic COVID-19 patients, the number of patients with Tapia syndrome may increase in the future.