scholarly journals Review of Critical Illness Myopathy and Neuropathy

2016 ◽  
Vol 7 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Starane Shepherd ◽  
Ayush Batra ◽  
David P. Lerner

Critical illness myopathy (CIM) and neuropathy are underdiagnosed conditions within the intensive care setting and contribute to prolonged mechanical ventilation and ventilator wean failure and ultimately lead to significant morbidity and mortality. These conditions are often further subdivided into CIM, critical illness polyneuropathy (CIP), or the combination—critical illness polyneuromyopathy (CIPNM). In this review, we discuss the epidemiology and pathophysiology of CIM, CIP, and CIPNM, along with diagnostic considerations such as detailed clinical examination, electrophysiological studies, and histopathological review of muscle biopsy specimens. We also review current available treatments and prognosis. Increased awareness and early recognition of CIM, CIP, and CIPNM in the intensive care unit setting may lead to earlier treatments and rehabilitation, improving patient outcomes.

Author(s):  
Mallory Kargela ◽  
Annette Siebens

Purpose: The purpose of this case is to illustrate the best available evidence to provide early therapeutic intervention for a critically ill patient presenting with cardiovascular and pulmonary complications due to multi-system compromise. Case Description: A 19-year-old male was admitted to the hospital with the diagnosis of necrotizing fasciitis and necrotizing pneumonia. He experienced numerous additional medical complications ultimately leading to tracheostomy, delirium, critical illness myopathy, and quadrilateral amputation secondary to necrotizing fasciitis and critical limb ischemia following prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO). Outcomes: Patient was discharged to an outside rehabilitation hospital after 103 days in the acute setting (56 days in the ICU) and was able to tolerate 40 minutes sitting edge of bed with supervision, perform bed mobility with supervision, and propel a standard wheelchair up to 50 feet independently. At 10 months’ post-discharge from the acute setting, the patient was ambulating independently up to 150 feet without assistive device using bilateral lower extremity prosthetics, able to propel a lightweight wheelchair community distances, independent in all transfers, and returned to school and work. Discussion: These findings suggest that clinicians may want to consider examining and combining the best available evidence of multiple medical conditions to provide a well-rounded therapeutic approach including but not limited to, close monitoring of vitals and early mobilization, to managing complex patients in the intensive care setting.


Author(s):  
Domenico Intiso ◽  
Antonello Marco Centra ◽  
Antonio Giordano ◽  
Andrea Santamato ◽  
Luigi Amoruso ◽  
...  

Patients with COVID-19 may develop a range of neurological disorders. We report here 4 COVID-19 subjects with intensive care unit-acquired weakness and their functional outcome. In addition, a scoping review of COVID-19 literature was performed to investigate this issue. Of the post-COVID-19 patients admitted to our Neuro-Rehabilitation Unit, 4 (3 males, 1 female; mean age 59.2±8.62 years) had intensive care unit-acquired weakness, diagnosed with electromyography. Muscle strength and functional evaluation were performed on all patients with Medical Research Council, Disability Rating Scale and Functional Independence Measure, respectively, at admission, discharge and 6-month follow-up. Electromyography revealed that 3 subjects had critical illness polyneuropathy and 1 had critical illness polyneuropathy/critical illness myopathy. At follow-up, the 3 subjects with critical illness polyneuropathy reached full recovery. The patient with critical illness polyneuropathy/critical illness myopathy showed moderate disability requiring bilateral ankle foot-orthosis and support for ambulation. The scoping review retrieved 11 studies of COVID-19 patients with intensive care unit-acquired weakness, concerning a total of 80 patients: 23 with critical illness myopathy (7 probable), 21 with critical illness polyneuropathy (8 possible), 15 with critical illness polyneuropathy and myopathy (CIPNM) and 21 with intensive care unit-acquired weakness. Of 35 patients who survived, only 3 (8.5%) reached full recovery. All 3 had critical illness myopathy, but 2 subjects had a diagnosis of probable critical illness myopathy. Intensive care unit-acquired weakness commonly occurred in subjects with COVID-19. Recovery was variable and a low percentage reached full recovery. However, the heterogeneity of studies did not allow definitive conclusions to be drawn.


2015 ◽  
Vol 6 (1) ◽  
pp. 9-35
Author(s):  
Daniel Agustin Godoy ◽  
Leonardo Vaz de Mello ◽  
Luca Masotti ◽  
Mario Di Napoli

Intensive care unit-acquired weakness (ICU-AW) is an increasingly complication of survivors of critical illness. It should be suspected in the presence of  a patient with a flaccid  tetraparesis or tetraplegia with hyporeflexia or absent deep tendon reflexes and difficult to weaning from mechanical ventilation in the absence of different diagnoses. Important risk factors are age, sepsis, illness duration and severity, some drugs (neuromuscular blockers, steroids). Electrophysiological studies have shown an axonal damage of involved peripheral nerves (critical illness polyneuropathy). However, muscle can also be primitively affected (critical illness myopathy) leading to ICUAW with inconstant myopathic damage patterns in electromyographic studies. Mixed forms can are present (critical illness polyneuromyopathy. Although the pathophysiology remains obscure, the hypothesis of an acquired channelopathy is substantial.Electroneuromyography is crucial for diagnosis. Muscular and nerve biopsy are necessary for diagnosis confirmation. Aggressive treatment of baseline disease, prevention, through avoiding or minimizing precipitating factors, strict glycemic control, and early rehabilitation combining mobilization with physiotherapy and muscle electrical muscle stimulation, are the keys to improving recovery of the affected individuals. This narrative review highlights the current literature regarding the etiology and diagnosis of ICU-AW.


Author(s):  
Didar Arslan ◽  
Rıza Dinçer Yıldızdaş ◽  
Özden Özgür Horoz ◽  
Nagehan Aslan ◽  
Yasemin Çoban ◽  
...  

Author(s):  
Priya S. Dhawan ◽  
Jennifer A. Tracy

Acquired weakness in critically ill patients is common, affecting between one-third to one-half of patients in the intensive care unit (ICU). Exposure to simultaneous stressors such as metabolic derangements, fluid and electrolyte shifts, infection, catabolic stress, and medications put patients in the ICU at risk for damage to both nerve and skeletal muscle with substantial and often lasting morbidity. Critical illness polyneuropathy is a length-dependent, axonal peripheral neuropathy occurring in patients in the ICU and unrelated to the primary illness. Critical illness myopathy is an ICU-associated muscle disorder occurring independently of denervation and uniquely identified by electrophysiologic and histologic characteristics.


2007 ◽  
Vol 8 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Stephen Williams ◽  
Iain A. Horrocks ◽  
Robert A. Ouvrier ◽  
Jonathan Gillis ◽  
Monique M. Ryan

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 127 ◽  
Author(s):  
Nicola Latronico ◽  
Giovanni Nattino ◽  
Bruno Guarneri ◽  
Nazzareno Fagoni ◽  
Aldo Amantini ◽  
...  

Objectives: To evaluate the accuracy of the peroneal nerve test (PENT) in the diagnosis of critical illness polyneuropathy (CIP) and myopathy (CIM) in the intensive care unit (ICU). We hypothesised that abnormal reduction of peroneal compound muscle action potential (CMAP) amplitude predicts CIP/CIM diagnosed using a complete nerve conduction study and electromyography (NCS-EMG) as a reference diagnostic standard.Design: prospective observational study.Setting: Nine Italian ICUs.Patients: One-hundred and twenty-one adult (≥18 years) neurologic (106) and non-neurologic (15) critically ill patients with an ICU stay of at least 3 days.Interventions: None.Measurements and main results: Patients underwent PENT and NCS-EMG testing on the same day conducted by two independent clinicians who were blind to the results of the other test. Cases were considered as true negative if both NCS-EMG and PENT measurements were normal. Cases were considered as true positive if the PENT result was abnormal and NCS-EMG showed symmetric abnormal findings, independently from the specific diagnosis by NCS-EMG (CIP, CIM, or combined CIP and CIM). All data were centrally reviewed and diagnoses were evaluated for consistency with predefined electrophysiological diagnostic criteria for CIP/CIM.During the study period, 342 patients were evaluated, 124 (36.3%) were enrolled and 121 individuals with no protocol violation were studied. Sensitivity and specificity of PENT were 100% (95% CI 96.1-100.0) and 85.2% (95% CI 66.3-95.8). Of 23 patients with normal results, all presented normal values on both tests with no false negative results. Of 97 patients with abnormal results, 93 had abnormal values on both tests (true positive), whereas four with abnormal findings with PENT had only single peroneal nerve neuropathy at complete NCS-EMG (false positive).Conclusions: PENT has 100% sensitivity and high specificity, and can be used to diagnose CIP/CIM in the ICU.


2020 ◽  
Author(s):  
Robert Frithiof ◽  
Elham Rostami ◽  
Eva Kumlien ◽  
Johan Virhammar ◽  
David Fällmar ◽  
...  

Abstract Background: Several reports on neurological complications associated with SARS-CoV-2 infection have been published. However, systematic description on intensive care unit acquired weakness (ICUAW) are still missing. Methods: The objective was to determine the incidence and characteristics of critical illness polyneuropathy (CIN) and myopathy (CIM) in patients with severe COVID-19. We also aimed to describe the electrophysiological features and their relation to plasma biomarkers for neuronal injury. This was a prospective observational intensive care unit cohort study. All adult patients admitted to the general intensive care unit (ICU) at Uppsala University Hospital, Uppsala, Sweden, between March 13 and June 8, 2020 were screened for inclusion. Patients with PCR confirmed COVID-19 were included. All patients were admitted to intensive care treatment due to severe COVID-19, including intravenous anaesthesia, opioid anaelgesia, neuromuscular blockade and mechanical ventilation. Associations of clinical, electrophysiological (sensory and motor conduction studies and electromyography) and biomarker data [neurofilament light chain (NfL), glial fibrillary acidic protein (GFAp) and tau] were studied between COVID-19 patients who developed CIN/CIM and those who did not. Results: 111 COVID-19 patients were included, 11 (11 males, mean age: 64 years) developed CIN/CIM whereas 100 (74 males, mean age: 61 years) did not (non-CIN/CIM). The CIN/CIM incidence was higher in COVID-19 patients compared to a general ICU-population treated during 2019 (9.9% vs 3.4%). In particular CIN was more frequent in the COVID-19 ICU cohort (50%) compared with the non-COVID-19 ICU cohort (0%, p=0.008). NfL and GFAp levels were higher in the CIN/CIM group both at the early (<9 days) and late time points (>11 days) compared with the non-CIN/CIM group (both p=0.001) and correlated with nerve amplitudes. Conclusions: CIN/CIM, in particular CIN, were more prevalent among COVID-19 patients than an ICU treated control cohort and should be considered in the differential diagnostic workup and the further rehabilitation of COVID-19 patients. COVID-19 patients who later developed ICUAW had significantly higher NfL and GFAp in the early phase of ICU care, which suggests their potential as predictive biomarkers. Trial registration: The study protocol was registered (ClinicalTrialsID:NCT04316884). Mechanisms for Organ Dysfunction in Covid-19 (UMODCOVID19) March 18, 2020.


Author(s):  
Matthew Baldwin ◽  
Hannah Wunsch

Many critically ill patients now survive what were previously fatal illnesses, but long-term mortality after critical illness remains high. While study populations vary by country, age, intervention, or specific diagnosis, investigations demonstrate that the majority of additional deaths occur in the first 6 to 12 months after hospital discharge. Patients with diagnoses of cancer, respiratory failure, and neurological disorders leading to the need for intensive care have the highest long-term mortality, while those with trauma and cardiovascular diseases have much lower long-term mortality. Use of mechanical ventilation, older age, and a need for care in a facility after the acute hospitalization are associated with particularly high 1-year mortality among survivors of critical illnesses. Due to challenges of follow-up, less is known about causes of delayed mortality following critical illness. Longitudinal studies of survivors of pneumonia, stroke, and patients who require prolonged mechanical ventilation suggest that most debilitated survivors die from recurrent infections and sepsis. Potential biologic mechanisms for increased risk of death after a critical illness include sepsis-induced immunoparalysis, intensive care unit-acquired weakness, neuroendocrine changes, poor nutrition, and genetic variance. Studies are needed to fully understand how the severity of the acute critical illness interacts with comorbid disease, pre-illness disability, and pre-existing and acquired frailty to affect long-term mortality. Such studies will be fundamental to improve targeting of rehabilitative, therapeutic, and palliative interventions to improve both survival and quality of life after critical illness.


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