Neuromuscular causes of prolonged ventilator dependency

Abstract

We prospectively evaluated 21 patients with prolonged ventilator dependency, to determine the frequency of unsuspected neuromuscular disease as a cause of this condition, and to determine the types of such diseases. Assessment was performed with routine and specialized electrophysiologic procedures. None of the patients had known prior neuromuscular disease, and none had ongoing medical problems that could account for their continued ventilator dependency. Sixty-two percent were found to have a neuromuscular disease severe enough to account for the ventilator dependency. Most of the remaining cases had a contributory neuromuscular disease. In addition to critical illness polyneuropathy, several other significant categories were identified. Myopathic EMG changes were found in 50% of the subgroup assessed by quantitative EMG. We conclude that neuromuscular disease is the most important factor in prolonged ventilator dependency, and that diseases other than critical illness polyneuropathy represent an important cause of this syndrome.

Respiratory muscles and weaning failure

“…Aetiology is unknown, although sepsis, multiple organ failure, shock, hypoxia, medications and prolonged use of neuromuscular blocking agents have been implicated [36]. Electrophysiological studies have revealed abnormalities of primarily axonal degeneration type [29,36,37]. Although CIP is usually improved in parallel with the underlying disease, weaning is difficult and the mortality rate is high in these patients [29,35].…”

Role of Electrical Muscle Stimulation (EMS) for Treatment or Prevention of ICU-associated Weakness

“…Weakness acquired in the intensive care unit (ICU) and related acquired neuromuscular dysfunction occur in a large percentage of critically ill patients [1][2][3] and are associated with increased morbidity and mortality [4,5]. Critical illness polyneuromyopathy (CIPNM) is an acquired neuromuscular disorder observed in survivors of acute critical illness.…”

“…The diagnosis of CIPNM requires a reliable bedside muscle strength examination and depends on patient's cooperation and maximal effort [4]. Several risk factors have been identified including systemic inflammatory response and sepsis [5], medications such as corticosteroids [6] and neuromuscular blocking agents [7], inadequate glycemic control [8], protracted immobility [4], hypoalbuminemia [9], Gram-negative bacteremia [9] and severity of organ dysfunction [10]. A very few of studies available suggesting the treatment and prevention of critical illness myopathy these includes intensive insulin therapy, optimal glycemic control and minimized use of neuromuscular blocking agents, high dose and prolong use of corticosteroids.…”

Electrodiagnostic Test: An Important Tools in the Evaluation of Critical Illness Neuromuscular Complications

“…Spitzer et al reported that 62% of patients with prolonged weaning from ventilation had an unsuspected neuromuscular disorder 2 . However, patients who become critically ill and survive their ICU stay often go on to have significant impairment directly related to a critical illness neuromuscular disorder.…”