Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis

Background: Electrophysiological studies show that critical illness polyneuromyopathy appears in the early stage of sepsis before the manifestation of clinical findings. The metabolic response observed during sepsis causes glutamine to become a relative essential amino acid. Aims: We aimed to assess the changes in neuromuscular transmission in the early stage of sepsis after glutamine supplementation. Study Design: Animal experimentation. Methods: Twenty male Sprague-Dawley rats were randomized into two groups. Rats in both groups were given normal feeding for one week. In the study group, 1 g/kg/day glutamine was added to normal feeding by feeding tube for one week. Cecal ligation and perforation (CLP) surgery was performed at the end of one week. Before and 24 hours after CLP, compound muscle action potentials were recorded from the gastrocnemius muscle. Results: Latency measurements before and 24 hours after CLP were 0.68±0.05 ms and 0.80±0.09 ms in the control group and 0.69±0.07 ms and 0.73±0.07 ms in the study group (p<0.05). Conclusion: Since enteral glutamine prevented compound muscle action potentials (CMAP) latency prolongation in the early phase of sepsis, it was concluded that enteral glutamine replacement might be promising in the prevention of neuromuscular dysfunction in sepsis; however, further studies are required.

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“…It is used as an electrodiagnostic test in animals, where amplitude, latency and duration are evaluated (2,3,(15)(16)(17)(18).…”

Section: Electrophysiological Recordingsmentioning

confidence: 99%

Neuromuscular Dysfunction in Experimental Sepsis and Glutamine

et al. 2016

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“…Risk factors for development of ICUAW include SIRS, sepsis, MOF, prolonged ICU length of stay, duration of mechanical ventilation [5 days, female sex, NMB agents, hyperglycemia, renal replacement therapy, use of catecholaminergic agents, and renal replacement therapy. The ICUAW is common, with an incidence ranging from 25 % in patients mechanically ventilated for more than 7 days up to 100 % in patients with sepsis and multiorgan failure [9,10].…”

Section: Neuromuscular Weakness In the Icumentioning

confidence: 99%

Early Mobilization in the Intensive Care Unit

Schober

Thornton

2013

Curr Anesthesiol Rep

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Survivors of critical illness frequently suffer from disability associated with neuromuscular weakness. This can substantially impact their quality of life and ability to return home, and often results in the need for further rehabilitation. Early and aggressive physical and occupational therapy, beginning upon admission to the intensive care unit, can substantially reduce this functional disability and has been shown to impact numerous parameters including ICU and hospital length of stay, time needed to wean from mechanical ventilation, the incidence of delirium, and even rates of readmission and post-discharge mortality. While early mobilization has been shown to be both safe and feasible in a variety of ICU settings, it requires an interdisciplinary approach and changes to the 'culture' of the ICU. While the early results have been very encouraging, more research is needed to identify the optimal approach and the full extent of the benefits it may offer.

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“…ENG signs of axonopathy may be present as early as 4 days after ICU admission [5]. Moreover, electrophysiological disturbances can be found in the early stage of the inflammatory response 2-5 days after admission to ICU before clinical evidence of neuromuscular damage evolves [27]. While the involvement of motor fibers predominates in most cases [14] also sensory abnormalities are found [28].…”

Section: Diagnostic Featuresmentioning

confidence: 99%

Neurological Sequelae of Sepsis: II) Neuromuscular Weakness

Axer¹

2011

TOCCMJ

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Abstract:Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) have been established as separate entities of muscular weakness in critically ill patients, although both may be associated to each other in some respects. Both are associated to systemic inflammatory response syndrome, sepsis, and severe sepsis. Major signs of nerve and muscle disturbances in critically ill patients are muscle weakness and problems of weaning from the ventilator. Electroneurographic measurements help to detect CIP early in the course of the disease, while muscle biopsy seems to date the diagnostic tool of choice to detect CIM. Sepsis therapy is the major target to prevent the development of CIP and CIM. However, no specific therapy of CIP and CIM has been established in the past. Therefore, management of patients with CIP and CIM is mainly supportive. Neuromuscular weakness cause elongated times of ventilation, elongated hospital stay, elongated times of rehabilitation, and increased mortality. This review provides an overview of clinical and diagnostic features of CIP and CIM, and summarizes current pathophysiological and therapeutic concepts.

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Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis

Abstract: Because neuromuscular abnormalities seem to develop earlier than previously reported, electroneuromyography should be used more frequently as a diagnostic test.

Cited by 215 publications

References 6 publications

Neuromuscular Dysfunction in Experimental Sepsis and Glutamine

Neuromuscular Dysfunction in Experimental Sepsis and Glutamine

Early Mobilization in the Intensive Care Unit

Neurological Sequelae of Sepsis: II) Neuromuscular Weakness

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