Introducing simplified electrophysiological test of peripheral nerves and muscles in the ICU: choosing wisely

Predictive value for weakness and 1-year mortality of screening electrophysiology tests in the ICU

“…The most obvious explanation that reduced CMAP predicts weakness, which by itself contributes to 1-year mortality, was invalidated as the association between reduced CMAP and 1-year mortality was independent of weakness. This suggests that CMAP reduction and weakness possibly identify different, though overlapping, phenotypes of neuromuscular involvement, as recently hypothesized [14]. Alternatively, this could point to subclinical weakness not captured by the MRC sum-score.…”

“…In this subset, electrophysiological testing was performed on day 8 (IQR 8-9) and MRC sum-score on day 10 (IQR [8][9][10][11][12][13][14]. The delay from electrophysiological testing up to the clinical evaluation was 2 days (IQR 0-6).…”

“…Electrophysiological screening including the quantification of compound muscle action potentials (CMAP), sensory nerve action potentials (SNAP), and the presence of spontaneous electrical activity (SEA) could serve as an alternative diagnostic tool in such cases ( Fig. 1) [12][13][14]. However, diagnostic properties of abnormal CMAP, SNAP, and SEA for weakness in the ICU are not well characterized.…”

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

“…In a more recent study 33 , sensitivity and specificity of combined peroneal nerve CMAP and sural nerve SNAP evaluations were 100% and 81%, respectively. However, in both studies all electrophysiological measurements were performed by the same investigators, and no blind assessment of the reference diagnostic test was implemented 35 .…”

A guided approach to diagnose severe muscle weakness in the intensive care unit

“…( 1 , 7 ) Because these electrophysiological studies are time-consuming and require specialized personnel, simplified tests have been proposed to be used as screening tests. ( 8 ) Unilateral peroneal and sural nerve conduction studies can accurately screen for CIP and CIM in ICU patients. ( 9 ) A single nerve test (the peroneal nerve test) has been validated in two multicenter studies as a 100% sensitivity test compared to a complete nerve conduction study and electromyography in the diagnosis of CIP/CIM, ( 10 ) and it can be performed in 10 minutes.…”