Neuromuscular Blockade in the Intensive Care Unit: More than We Bargained for

Hansen‐Flaschen, John; Cowen, Jay; Raps, Eric C.

doi:10.1164/ajrccm/147.1.234

Cited by 174 publications

(48 citation statements)

References 31 publications

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“…Muscle relaxants like vecuronium should not be used for more than 24 to 48 hrs. If used over several days with high dose of corticosteroids, muscle relaxants appear to contribute to the development of an acute, diffuse myopathy [3]. The resulting muscle weakness can be profound and recovery may require many months of rehabilitation and even then may be incomplete.…”

Section: Discussionmentioning

confidence: 99%

Ventilatory Strategy in Acute Severe Asthma

Sharma

Sk²

2004

Medical Journal Armed Forces India

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Section: Discussionmentioning

confidence: 99%

Ventilatory Strategy in Acute Severe Asthma

Sharma

Sk²

2004

Medical Journal Armed Forces India

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“…However, recent prospective and retrospective studies have shown that this is an under-appreciated entity, which is a significant source of morbidity in the ICU, and has significant economic consequences on the usage of health resources. [2][3][4] There is compelling evidence that this syndrome is associated with altered muscle membrane properties and selective loss of myosin and myosin-associated proteins. The altered membrane properties are most probably the primary cause of the absent or very low compound muscle action potentials and the increased amount of spontaneous EMG activity.…”

Section: Discussionmentioning

confidence: 99%

Acute quadriplegic myopathy following autologous peripheral blood stem cell transplantation for breast cancer

Samuelsson¹,

Zackrisson

Tokics³

et al. 1999

Bone Marrow Transplant

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Summary:Autologous peripheral blood stem cell transplantation (APSCT) is increasingly used in the treatment of breast cancer. We report a patient who experienced septic shock, and after treatment with antibiotics, high-dose corticosteroids and mechanical ventilation due to respiratory insufficiency, developed quadriplegia. Electroneurophysiological examination, as well as a muscle biopsy, showed a typical picture of acute quadriplegic myopathy with loss of thick filament proteins. This is, to the best of our knowledge, the first reported case of this complication following APSCT.

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“…Steroids and neuromuscular blockade have been associated with rhabdomyolysis, although the exact mechanism is unknown [32]. Cushing first described the association between steroid excess and muscular weakness in 1932 [33].…”

Section: Etiologiesmentioning

confidence: 99%

Crush injury and rhabdomyolysis

Malinoski

Slater

Mullins

2004

Critical Care Clinics

200

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Although clinical syndromes consistent with rhabdomyolysis were recognized in the late 19th and early 20th centuries, the modern history of the crush syndrome begins with Bywaters' and Beal's classic description of the entrapped bombing victims of London during World War II [1 -4]. They reported five cases of crush injury, in which victims had one or more of their extremities trapped under debris for prolonged periods of time. All five patients presented in shock, had swollen extremities, developed dark urine, progressed to renal failure, and eventually died. Histologic examination of the kidney revealed tubular necrosis and pigmented casts. In 1944, Bywaters and Stead identified myoglobin as the urinary pigment and proposed its role in the development of renal failure [5].Large numbers of patients with crush injuries and rhabdomyolysis have been reported after the collapse of mines [6,7], severe beatings [8], and earthquakes [9 -15]. In the United States, alcohol intoxication associated with prolonged muscle compression and seizures is the most common etiology of rhabdomyolysis [16]. Serum creatine kinase (CK) levels correlate with the degree of muscle injury [14] and can be used to assess the severity of rhabdomyolysis. Acute renal failure (ARF) is one of the most serious consequences of rhabdomyolysis and occurs in 4% to 33% of cases, carrying with it a mortality rate of 3% to 50% [17]. Rhabdomyolysis accounts for 5% to 7% of all cases of ARF in the United States [18].This article focuses on the pathophysiology and treatment of myoglobinuric renal failure caused by traumatic rhabdomyolysis and crush injuries.

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Neuromuscular Blockade in the Intensive Care Unit: More than We Bargained for

Cited by 174 publications

References 31 publications

Ventilatory Strategy in Acute Severe Asthma

Ventilatory Strategy in Acute Severe Asthma

Acute quadriplegic myopathy following autologous peripheral blood stem cell transplantation for breast cancer

Crush injury and rhabdomyolysis

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