Critical illness polyneuropathy and myopathy: a systematic review

Abstract

Critical illness polyneuropathy and critical illness myopathy are frequent complications of severe illness that involve sensorimotor axons and skeletal muscles, respectively. Clinically, they manifest as limb and respiratory muscle weakness. Critical illness polyneuropathy/myopathy in isolation or combination increases intensive care unit morbidity via the inability or difficulty in weaning these patients off mechanical ventilation. Many patients continue to suffer from decreased exercise capacity and compromised quality of life for months to years after the acute event. Substantial progress has been made lately in the understanding of the pathophysiology of critical illness polyneuropathy and myopathy. Clinical and ancillary test results should be carefully interpreted to differentiate critical illness polyneuropathy/myopathy from similar weaknesses in this patient population. The present review is aimed at providing the latest knowledge concerning the pathophysiology of critical illness polyneuropathy/myopathy along with relevant clinical, diagnostic, differentiating, and treatment information for this debilitating neurological disease.

Clinical Approach and Guidelines for Management of Sepsis Associated Encephalopathy

“…Early rehabilitation combined with mobilization is a therapeutic and preventive strategy for patients with critical conditions and can improve long-term improvement and functional dependence of patients, and shorten the duration of ventilator use. 33 CIM with or without CIP occurrence will enhance followed with the increasing of treatment length in the ICU, and the hospital can increase the mortality rate. Spontaneous repair can occur weekly in mild cases and monthly in moderate circumstances.…”

Análise da força muscular expiratória e respiração espontânea de indivíduos em ventilação mecânica: estudo transversal

“…CIPNM diagnosis requires invasive methods, of difficult interpretation and limited by conditions as low level of consciousness, edema and previous neuropathy 29 . The Medical Research Council Sum Score (MRC-SS) is used in the diagnostic hypothesis for identifying the MWA-ICU, but it also requires cooperation of the patient 29,42 . Tzanis et al 43 found correlation between MIP and the MRC-SS, showing that this could be an alternative.…”

Polynevromyopati hos intensivpasienter

“…De senere år har det skjedd en enorm utvikling med å kartlegge de patofysiologiske prosesser omkring utviklingen av CIPNM (8). Mekanismene er komplekse og skyldes strukturelle og funksjonelle endringer og forstyrrelser, både i nerver og muskler.…”

“…CIM skyldes i hovedsak muskelatrofi på grunn av økt nedbrytning av muskulatur eller mangel på syntese av muskelprotein. Muskelatrofi hos intensivpasienter kan også komme av immobilitet, betennelse, underernaering/malnutrisjon og nedsatt mikrosirkulasjon, i tillegg til metabolsk derangering, reversibel nervekanalpatologi og bioenergetisk dysfunksjon (3,8).…”

“…Det finnes ingen spesifikk behandling for CIPNM. Foreslåtte tiltak som aggressiv behandling av sepsis, redusert dose-og behandlingsvarighet av muskelrelaksantia og kortikosteroider, rehabiliteringsprogram, ernaeringstiltak, antioksidantterapi, testosteronderivater, veksthormon og immunglobulinterapi har vaert forsøkt med varierende resultat (8). Dette understreker viktigheten av tidlig identifikasjon og forebygging.…”