Neuromuscular involvement in COVID-19 critically ill patients

Cabañés-Martínez, Lidia; Villadóniga, Marta; González-Rodríguez, Liliana G.; Araque, Lesly; Díaz-Cid, Alba; Ruz-Caracuel, Ignacio; Pián, Héctor; Sánchez-Alonso, Susana; Fanjul, Samira; Álamo, Marta del; Regidor, Ignacio

doi:10.1016/j.clinph.2020.09.017

Cited by 99 publications

(153 citation statements)

References 28 publications

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confidence: 99%

“…With interest we read the article by Cabañes-Martínez et al about 12 patients with COVID-19 and a negative history for neuromuscular disorders (NMDs), who developed muscle weakness and respiratory failure during hospitalization on the intensive care unit (ICU) for complications of the viral infection ( Cabañes-Martínez et al, 2020 ). The authors found that 11 of these patients had critical ill neuropathy (CIN) or critical ill myopathy (CIM) ( Cabañes-Martínez et al, 2020 ). It was concluded that the prevalence of CIN and CIM will increase with the increasing number of COVID-19 patients requiring ICU treatment and that nerve conduction studies (NCSs) and electromyography (EMG) will play crucial roles in the work-up of neuro-COVID ( Cabañes-Martínez et al, 2020 ).…”

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confidence: 99%

“…The authors found that 11 of these patients had critical ill neuropathy (CIN) or critical ill myopathy (CIM) ( Cabañes-Martínez et al, 2020 ). It was concluded that the prevalence of CIN and CIM will increase with the increasing number of COVID-19 patients requiring ICU treatment and that nerve conduction studies (NCSs) and electromyography (EMG) will play crucial roles in the work-up of neuro-COVID ( Cabañes-Martínez et al, 2020 ). We have the following comments and concerns.…”

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confidence: 99%

“…Since 11 of the included patients received steroids ( Cabañes-Martínez et al, 2020 ), it is necessary to exclude a contribution of steroid myopathy to muscle weakness or respiratory failure. Four patients received meropenem, which may cause hypokalemia and thus may contribute to muscle weakness.…”

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confidence: 99%

“…Overall, the interesting report by Cabañes-Martínez et al (2020) has a number of shortcomings in addition to those listed as limitations in the article, which need to be addressed before drawing final conclusions. Work-up for muscle weakness should not only include NCSs of distal nerve segments and needle EMG but also NCSs of proximal nerve segments and SF-EMG.…”

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Comprehensive work-up is warranted for patients with severe COVID-19 and muscle weakness including respiratory muscles

Finsterer

2021

Clinical Neurophysiology

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Comprehensive work-up is warranted for patients with severe COVID-19 and muscle weakness including respiratory muscles

Finsterer

2021

Clinical Neurophysiology

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COVID‐19‐Associated Critical Illness Myopathy with Direct Viral Effects

Dodig

Tarnopolsky

Margeta

et al. 2022

Annals of Neurology

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Coronavirus disease 2019 (COVID-19) severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2 infection) can lead to intensive care unit (ICU) admission and critical illness myopathy (CIM). We examined 3 ICU patients with COVID-19 who required mechanical ventilation for pneumonia and developed CIM. Pathological examination of the skeletal muscle biopsies revealed myopathic changes consistent with CIM, variable inflammation with autophagic vacuoles, SARS-CoV immunostaining + fibers/granules, and electron microscopy findings of mitochondrial abnormalities and coronaviruslike particles. Although mitochondrial dysfunction with compromised energy production is a critical pathogenic mechanism of non-COVID-19-associated CIM, in our series of COVID-19-associated CIM, myopathic changes including prominent mitochondrial damage suggest a similar mechanism and association with direct SARS-CoV-2 muscle infection.

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Development and early diagnosis of critical illness myopathy in COVID‐19 associated acute respiratory distress syndrome

Rodríguez

Branca

Gutt-Will

et al. 2022

J cachexia sarcopenia muscle

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Background The COVID‐19 pandemic has greatly increased the incidence and clinical importance of critical illness myopathy (CIM), because it is one of the most common complications of modern intensive care medicine. Current diagnostic criteria only allow diagnosis of CIM at an advanced stage, so that patients are at risk of being overlooked, especially in early stages. To determine the frequency of CIM and to assess a recently proposed tool for early diagnosis, we have followed a cohort of COVID‐19 patients with acute respiratory distress syndrome and compared the time course of muscle excitability measurements with the definite diagnosis of CIM. Methods Adult COVID‐19 patients admitted to the Intensive Care Unit of the University Hospital Bern, Switzerland requiring mechanical ventilation were recruited and examined on Days 1, 2, 5, and 10 post‐intubation. Clinical examination, muscle excitability measurements, medication record, and laboratory analyses were performed on all study visits, and additionally nerve conduction studies, electromyography and muscle biopsy on Day 10. Muscle excitability data were compared with a cohort of 31 age‐matched healthy subjects. Diagnosis of definite CIM was made according to the current guidelines and was based on patient history, results of clinical and electrophysiological examinations as well as muscle biopsy. Results Complete data were available in 31 out of 44 recruited patients (mean [SD] age, 62.4 [9.8] years). Of these, 17 (55%) developed CIM. Muscle excitability measurements on Day 10 discriminated between patients who developed CIM and those who did not, with a diagnostic precision of 90% (AUC 0.908; 95% CI 0.799–1.000; sensitivity 1.000; specificity 0.714). On Days 1 and 2, muscle excitability parameters also discriminated between the two groups with 73% (AUC 0.734; 95% CI 0.550–0.919; sensitivity 0.562; specificity 0.857) and 82% (AUC 0.820; CI 0.652–0.903; sensitivity 0.750; specificity 0.923) diagnostic precision, respectively. All critically ill COVID‐19 patients showed signs of muscle membrane depolarization compared with healthy subjects, but in patients who developed CIM muscle membrane depolarization on Days 1, 2 and 10 was more pronounced than in patients who did not develop CIM. Conclusions This study reports a 55% prevalence of definite CIM in critically ill COVID‐19 patients. Furthermore, the results confirm that muscle excitability measurements may serve as an alternative method for CIM diagnosis and support its use as a tool for early diagnosis and monitoring the development of CIM.

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Neuromuscular involvement in COVID-19 critically ill patients

Abstract: Highlights Many COVID-19 patients require ICU stay which can result in neuromuscular damage. We describe a series of 11 patients with the diagnosis of ICU acquired weakness. Neurophysiology plays an essential role in the diagnosis of these patients.

Cited by 99 publications

References 28 publications

Comprehensive work-up is warranted for patients with severe COVID-19 and muscle weakness including respiratory muscles

Comprehensive work-up is warranted for patients with severe COVID-19 and muscle weakness including respiratory muscles

COVID‐19‐Associated Critical Illness Myopathy with Direct Viral Effects

Development and early diagnosis of critical illness myopathy in COVID‐19 associated acute respiratory distress syndrome

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