Approach to critical illness myopathy and polyneuropathy in the older SARS-CoV-2 patients

Abstract

One of the major concerns of the health care community and the public surrounding the SARS-CoV-2 pandemic is the availability and use of ventilators. Unprecedented surges of patients presented to intensive care units across the country, with older adults making up a large proportion of the patient population. This paper illustrates contemporary approaches to critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and critical illness polyneuromyopathy (CIPNM) in older patients, including incidence, risk factors, mechanisms for pathology, diagnosis, contemporary treatment approaches, and outcomes. We hope that the following analysis may help educate clinicians and ultimately decrease the duration of the mechanical ventilation required by these patients, resulting in improved clinical outcomes and an increase in ventilator availability for other patients in need.

Nerve conduction study and electromyography findings in patients recovering from Covid-19 – Case report

“…Polyneuropathy induced by corticosteroids or other drugs was previously reported in the literature, as was myopathy in critical illness treated in ICU before the pandemic ( Zink et al, 2009 , Yang et al, 2018 ). Some data was published on COVID-19 patients that required admission to the ICU which developed polyneuropathy ( McClafferty et al, 2020 ) and myopathy ( Bagnato et al, 2020 ) associated with the disease. We are already aware of anosmia ( Han et al, 2020 ) and ageusia resulting from direct damage due to the characteristic viral lysis of the neuronal tracts ( Lozada-Nur et al, 2020 ) in COVID-19 patients.…”

Guillain–Barre Syndrome Associated With COVID-19 Pneumonia—The First Documented Case in a U.S. Military Intensive Care Unit

“… 4 Critical illness myopathy (CIM) occurs even earlier, often presenting within days of critical illness. 17 Our patient developed a rapid-onset quadriparesis with areflexia following a successful extubation, ending 30 days of mechanical ventilation, which is not consistent with CIPN/CIM. In the setting of clinical patient improvement after extubation, our patient’s progressive limb and respiratory weakness is more consistent with GBS.…”

Electrodiagnostic findings in patients with non‐COVID‐19‐ and COVID‐19‐related acute respiratory distress syndrome

“…CIPNM is the most frequent neurological disease in COVID‐19 patients who develop neuromuscular complications 7–10,18,19 . CIPNM is characterized by different clinical, instrumental and biochemical features such as muscle wasting, impaired contractility, reduced deep tendon reflexes, neuropathy and muscle protein degradation (preferential loss of myosin is a distinct feature of this condition) 9 .…”

“…In addition, in most of the studies conducted on patients with COVID‐19, 5,9–11 the detection of CIPNM was limited to the evaluation of clinical parameters based on the assessment of strength of both the upper and lower limbs, using the MRC scale. This clinical assessment may be subject to confounding factors often present in critically ill patients (such as impaired consciousness level due to different causes, i.e., the use of sedation drugs or poor patient cooperation) that could under‐ or overestimate the presence of CIPNM.…”

“…Increasing amounts of scientific literature have reported that approximately 35–40% of patients with COVID‐19 developed several neurological symptoms 5,6 including affections of muscles and the neuromuscular system, such as critical illness polyneuropathy and myopathy (CIPNM) 5,7–11 . CIPNM is usually one of the leading causes of intensive care unit‐acquired weakness (ICUAW) in critically ill patients and represents a common neurological disease frequently observed in critically ill patients treated in intensive care units (ICUs) for different reasons 12 .…”