Critical illness polyneuromyopathy in septic patients: Is it possible to diagnose it in a bedside clinical examination?

Abstract

Objective: To determine the sensitivity and specificity of peripheral and respiratory muscle strength tests in diagnosing critical illness polyneuromyopathy (CIPNM), compared with an electrophysiological examination. Methods: Fifty septic patients who required mechanical ventilation for at least five days, and without a previous history of muscle weakness, were included. Peripheral muscle strength was assessed using the Medical Research Council (MRC) score, handgrip strength by dynamometry, and respiratory muscle strength with maximum respiratory pressures. Diagnosis of CIPNM was either confirmed or rejected by an electrophysiological examination. Receiver operating characteristic curve analysis was performed to determine the cut-off values with the best sensitivity (SN) and specificity (SP) of the studied variables in the presence or absence of CIPNM. Results: Patients with CIPNM were older, more critical (APACHE IV/SAPS 3), had a longer hospitalization, required mechanical ventilation for longer, and had a higher rate of intensive care unit readmission. Cutoff values identified CIPNM patients using MRC scores, dynamometry according to sex, maximal expiratory and inspiratory pressures, as well as being confirmed by the electrophysiological examination, with good sensitivity and specificity: < 40 (SN: 0.893; SP: 0.955); < 7 kg (SN: 1; SP: 0.909) for men, < 4 kg (SN: 0.882; SP: 1) for women; < 34 cmH2O (SN: 0.808; SP: 0.909) and > −40 cmH2O (SN: 0.846; SP: 0.909), respectively. Conclusion: The MRC score, dynamometry or maximum respiratory pressures can be used to identify patients with CIPNM at the intensive care bedside assessment. The healthcare professional can choose any of the methods studied to evaluate the patient, based on his experience and the resource available.

Handgrip Force and Maximum Inspiratory and Expiratory Pressures in Critically Ill Patients With a Tracheostomy

“…A MIP threshold of 36 cm H 2 O can indicate ICU-AW (sensitivity, 88%; specificity, 76%). 11,36 This fact suggests that ICU-AW involves all skeletal muscles. 11,37 The strong correlation between HGF and MEP (which corresponds to the maximum strength of the Both mean inspiratory pressure and mean expiratory pressure were correlated with handgrip force.…”

Bedside voluntary and evoked forces evaluation in intensive care unit patients: a narrative review

“…A four-point ordinal scale has been recently introduced but remains to be validated on a large cohort of patients [ 26 ]. An MRC sum-score < 40 has been proposed as a modality to specifically diagnose patients with CIPNM [ 27 ]. However, this study suffers from several limitations such as highly selective inclusion criteria ( i.e.…”

“…measurements are not fully standardized among studies in ICU patients [ 31 ]. A majority of studies followed the recommendations of the American Society of Hand Therapists by performing testing in a seated position [ 10 , 19 , 27 , 32 – 37 ] while other investigations used a supine position to take into account the patients’ inability to maintain a stable vertical position [ 11 , 24 , 38 – 41 ]. Both shoulder and forearm were in neutral/rotation position when testing in seated position while the elbow joint angle varied from 90° of flexion to full extension when testing in supine position.…”

“…Lower cut-off values ( i.e. 7 kg for men and 4 kg for women) were reported in septic patients diagnosed with CIPNM [ 27 ]. However, these results should be interpreted with caution considering the above-mentioned methodological limitations of this study [ 27 ].…”

“…7 kg for men and 4 kg for women) were reported in septic patients diagnosed with CIPNM [ 27 ]. However, these results should be interpreted with caution considering the above-mentioned methodological limitations of this study [ 27 ]. Surprisingly, no study has investigated if HHD could be used to diagnose ICUAW despite its good to excellent reliability (Table 2 and Fig.…”