scholarly journals Critical Illness Polyneuropathy and Myopathy in COVID-19 Patients: A Prospective Observational Intensive Care Unit Cross-Sectional Cohort Study

2020 ◽  
Author(s):  
Robert Frithiof ◽  
Elham Rostami ◽  
Eva Kumlien ◽  
Johan Virhammar ◽  
David Fällmar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Critical Illness ◽  
Predictive Biomarkers ◽  
Critical Illness Polyneuropathy ◽  
University Hospital ◽  
Intensive Care Treatment ◽  
Late Time ◽  
Neurofilament Light Chain

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.

scholarly journals Evaluation of Critical Illness Polyneuropathy/Myopathy in Pediatric Intensive Care Unit

2020 ◽  
Vol 7 (3) ◽  
pp. 108-111
Author(s):  
Didar Arslan ◽  
Rıza Dinçer Yıldızdaş ◽  
Özden Özgür Horoz ◽  
Nagehan Aslan ◽  
Yasemin Çoban ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Critical Illness Polyneuropathy

Myopathy and Neuropathy Acquired in the Intensive Care Unit

2019 ◽  
pp. 677-684
Author(s):  
Priya S. Dhawan ◽  
Jennifer A. Tracy
Keyword(s):  
Skeletal Muscle ◽  
Intensive Care Unit ◽  
At Risk ◽  
Intensive Care ◽  
Peripheral Neuropathy ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Critical Illness Polyneuropathy ◽  
Muscle Disorder

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.

scholarly journals Validation of the peroneal nerve test to diagnose critical illness polyneuropathy and myopathy in the intensive care unit: the multicentre Italian CRIMYNE-2 diagnostic accuracy study

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 127 ◽  
Author(s):  
Nicola Latronico ◽  
Giovanni Nattino ◽  
Bruno Guarneri ◽  
Nazzareno Fagoni ◽  
Aldo Amantini ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Peroneal Nerve ◽  
Compound Muscle Action Potential ◽  
False Negative ◽  
High Specificity ◽  
Critical Illness Polyneuropathy ◽  
True Positive ◽  
True Negative

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.

Effect of Transcutaneous Electrical Neuromuscular Stimulation on Myopathy in Intensive Care Patients

2018 ◽  
Vol 27 (6) ◽  
pp. 495-503 ◽  
Author(s):  
Evangelia Koutsioumpa ◽  
Demosthenes Makris ◽  
Athina Theochari ◽  
Dimitra Bagka ◽  
Stathis Stathakis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Physical Therapy ◽  
Intensive Care Unit Stay ◽  
Controlled Trial ◽  
University Hospital ◽  
Control Group ◽  
Neuromuscular Stimulation ◽  
Open Label

Background Critical illness polyneuropathy or myopathy is a severe disorder that may adversely affect patients in the intensive care unit, resulting in reduced mobilization, decline in muscle mass, and prolonged recovery periods. Objective To examine whether the application of trans-cutaneous electrical neuromuscular stimulation (TENMS) reduces the incidence or severity of myopathy related to critical illness in intensive care unit patients. Methods A total of 80 patients aged 18 years or older with an intensive care unit stay of 96 hours or more and receipt of mechanical ventilation for 96 hours or more were initially enrolled in a prospective, open-label randomized controlled trial in a university hospital. Patients received either conventional physical therapy alone (control group) or conventional physical therapy plus TENMS (TENMS group) for 10 days. Myopathy was assessed histologically (by needle biopsy of the quadriceps muscles) on the 4th and 14th days of the intensive care unit stay. Results Of the 68 patients who completed the study, 27 (40%) had myopathy on the 14th day: 11 patients in the TENMS group (9 mild, 1 moderate, and 1 severe) and 16 patients in the control group (13 mild, 2 moderate, and 1 severe). Patients who progressed from mild to moderate or severe myopathy between the 4th and 14th days had significantly lower body mass index (P = .001) and longer time periods with inadequate nutrition (P = .049) compared with the other patients. Mean (SD) Rankin scale scores at 6 months were 3.2 (1.8) and 3.8 (2.1) in the TENMS and control groups, respectively (P = .09). Conclusion TENMS had no significant impact on myopathy in the critically ill patients in this study.

scholarly journals Glucose control in the intensive care unit: how it is done

2007 ◽  
Vol 66 (3) ◽  
pp. 362-366 ◽  
Author(s):  
Jane Harper
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Glycaemic Control ◽  
Glucose Control ◽  
University Hospital ◽  
Glucose Measurement ◽  
Tight Glycaemic Control ◽  
Glucose Levels ◽  
Attention To Detail

Hyperglycaemia occurs in the majority of critically-ill patients, partly because patients are hypercatabolic and consequently have increased glucose levels and partly because of insulin resistance. Hyperglycaemia is associated with increased mortality in critical illness. In 2001 it was shown that mortality and other complications of critical illness can be decreased by adopting ‘tight’ glycaemic control (4·1–6·4 mmol/l). The critical care world adopted tight glycaemic control enthusiastically, until it became apparent that profound life-threatening hypoglycaemia could result. Most clinicians, currently, have adopted regimens aiming to control glucose between 4 and 8 mmol/l. Practising this regimen safely requires attention to detail. Patients must be provided with energy as well as insulin; preferably via the enteral route, but parenterally if necessary. Insulin is administered according to a relatively simple scale that is adjustable by nursing staff according to patients' glucose results. Frequent glucose measurement is essential to success, along with using visual charting that makes sudden changes in blood glucose levels obvious. There are several ‘champions’ of safe implementation of glucose control in the intensive care unit at the Royal Liverpool University Hospital who are educators and who feed results back to staff regularly. Further studies will clarify the ultimate role of tight glycaemic control, but it can be done safely with meticulous attention to detail.

scholarly journals Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study

Critical Care ◽  
2014 ◽  
Vol 18 (3) ◽  
pp. R125 ◽  
Author(s):  
Annemiek E Wolters ◽  
Diederik van Dijk ◽  
Wietze Pasma ◽  
Olaf L Cremer ◽  
Marjolein F Looije ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Critical Illness ◽  
Intensive Care Unit Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Incidence and predictors of mortality among children admitted to the pediatric intensive care unit at the University of Gondar comprehensive specialised hospital, northwest Ethiopia: a prospective observational cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036746
Author(s):  
Nahom Worku Teshager ◽  
Ashenafi Tazebew Amare ◽  
Koku Sisay Tamirat
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Critical Illness ◽  
Northwest Ethiopia ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
Predictors Of Mortality ◽  
Observational Cohort ◽  
The University

ObjectiveTo determine the incidence and predictors of mortality among children admitted to the paediatric intensive care unit (PICU) at the University of Gondar comprehensive specialised hospital, northwest Ethiopia.DesignA single-centre prospective observational cohort study.ParticipantsA total of 313 children admitted to the ICU of the University of Gondar comprehensive specialised hospital during a one-and-a-half-year period.MeasurementsData were collected using standard case record form, physical examination and patient document review. Clinical characteristics such as systolic blood pressure, pupillary light reflex, oxygen saturation and need for mechanical ventilation (MV) were assessed and documented within the first hour of admission and entered into an electronic application to calculate the modified Pediatric Index of Mortality 2 (PIM 2) Score. We fitted the Cox proportional hazards model to identify predictors of mortality.ResultThe median age at admission was 48 months with IQR: 12–122, 28.1% were infants and adolescents accounted for 21.4%. Of the total patients studied, 59.7% were males. The median observation time was 3 days with (IQR: 1–6). One hundred and two (32.6%) children died during the follow-up time, and the incidence of mortality was 6.9 deaths per 100 person-day observation. Weekend admission (adjusted HR (AHR)=1.63, 95% CI: 1.02 to 2.62), critical illness diagnoses (AHR=1.79, 95% CI: 1.13 to 2.85), need for MV (AHR=2.36, 95% CI: 1.39 to 4.01) and modified PIM 2 Score (AHR=1.53, 95% CI: 1.36 to 1.72) were the predictors of mortality.ConclusionThe rate of mortality in the PICU was high, admission over weekends, need for MV, critical illness diagnoses and higher PIM 2 scores were significant and independent predictors of mortality.

scholarly journals A cohort study investigating the occurrence of differences in care provided to men and women in an intensive care unit

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Erik Zettersten ◽  
Gabriella Jäderling ◽  
Max Bell ◽  
Emma Larsson
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Cohort Study ◽  
Intensive Care ◽  
Respiratory Disease ◽  
University Hospital ◽  
Men And Women ◽  
Logistic Regressions ◽  
To Receive

AbstractIt has been reported that there are differences in the care given within the intensive care unit (ICU) between men and women. The aim of this study is to investigate if any differences still exist between men and women regarding the level of intensive care provided, using prespecified intensive care items. This is a retrospective cohort study of 9017 ICU patients admitted to a university hospital between 2006 and 2016. Differences in use of mechanical ventilation, invasive monitoring, vasoactive treatment, inotropic treatment, echocardiography, renal replacement therapy and central venous catheters based on the sex of the patient were analysed using univariate and multivariable logistic regressions. Subgroup analyses were performed on patients diagnosed with sepsis, cardiac arrest and respiratory disease. Approximately one third of the patients were women. Overall, men received more mechanical ventilation, more dialysis and more vasoactive treatment. Among patients admitted with a respiratory disease, men were more likely to receive mechanical ventilation. Furthermore, men were more likely to receive levosimendan if admitted with cardiac arrest. We conclude that differences in the level of intensive care provided to men and women still exist.

Sign in / Sign up

Export Citation Format

Share Document