Peripheral Nerve Function in Sepsis and Multiple Organ Failure

Witt, Norbert; Zochodne, Douglas W.; Bolton, Charles F.; Grand’Maison, François; Wells, George A.; Young, G. Bryan; Sibbald, William J.

doi:10.1378/chest.99.1.176

Cited by 507 publications

(377 citation statements)

References 30 publications

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“…Condições determinantes de caquexia, tais como as doenças críticas crônicas, o câncer, o alcoolismo, a AIDS, as síndromes disabsortivas intestinais e os procedimentos cirúrgicos com redução de alças (malabsorção) são as principais causas de neuropatia periférica carencial 14 . Uma forma particular de neuropatia, a neuropatia dos pacientes críticos, também poderia ser considerada nos nossos pacientes, visto que ocorre em até 70% dos pacientes com sepsis ou falência de múltiplos órgãos 15 . Trata-se de polineuropatia axonal motora que envolve principalmente as fibras distais.…”

Section: Resultsunclassified

“…As combinações atuais não têm sido reportadas como lesivas, no entanto alguns autores sugerem que com o uso preferencial da politerapia, terapias em altas doses e terapias experimentais, a incidência de neuropatia periférica seguida ao uso de drogas continua aumentando, podendo traduzir um efeito aditivo ou sinérgico [10][11][12] . Outras desordens devem ser consideradas nesses pacientes submetidos ao TMO como as de origem carencial, séptica ou associada a falência de múltiplos órgãos que podem contribuir ou mesmo originar quadro neuropático nesses indivíduos [13][14][15] .…”

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Investigação de neuropatia periférica durante o período recente do transplante de medula óssea

Zétola

Scola

Pasqüini

et al. 1998

Arq. Neuro-Psiquiatr.

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RESUMO -Investigamos prospectivamente a incidência de neuropatia periférica em 43 pacientes através do estudo da velocidade de condução nervosa e do teste de limiar de sensibilidade vibratória (palestesiômetro) realizados antes e após o transplante de medula óssea. Nesse período as principais drogas utilizadas para o condicionamento e imunossupressão foram o bussulfan, ciclofosfamida, ciclosporina A, methotrexate e corticoesteróides. Foram estudadas as velocidades de condução nervosa nos nervos mediano motor, fibular, tibial, mediano sensitivo e sural. Obtivemos alterações estatisticamente significativas na duração do potencial composto proximal do nervo mediano motor, na amplitude distal do nervo tibial posterior e na amplitude proximal do nervo sural. As diferenças observadas não se correlacionaram com alterações clínicas, e não foram suficientes para o diagnóstico de neuropatia periférica. Acreditamos que o esquema terapêutico utilizado não provoca toxicidade neurológica periférica no período recente do transplante de medula óssea.PALAVRAS-CHAVE: neuropatia periférica, estudo de condução nervosa, transplante de medula óssea. Peripheral neuropathy investigation in the early stage of bone marrow transplantationABSTRACT -Forty-three patients with several hematological diseases in the early stage of bone marrow transplantation were prospectively studied. All patients underwent a complete neurological examination, vibratory sense perception test and nerve conduction study both before and after the bone marrow transplantation. The following nerves were studied: median, peroneal, posterior tibial (motor), median and sural (sensitive). Most patients were in busulphan, cyclophosphamide, cyclosporine A, methotrexate and corticosteroids. Although the results showed statistical differences in the nerve conduction study, all of these differences were not sufficient to induce or diagnose peripheral nerve injury. Therefore, it was concluded that drugs used in the bone marrow transplantation do not induce peripheral neuropathy.KEY WORDS: peripheral neuropathy, nerve conduction study, bone marrow transplantation.O transplante de medula óssea (TMO) é considerado, atualmente, o segundo transplante de órgão mais frequente, sendo tratamento de escolha para uma série de doenças malignas hematológicas, não-hematológicas, genéticas e imunológicas [1][2][3] . O controle e manejo de suas complicações é objeto de muitos estudos que buscam evitar a toxicidade das drogas, a rejeição e falência do enxerto, a doença enxerto contra hospedeiro e as infecções oportunistas. As complicações neurológicas ainda são frequentes e causam óbito em aproximadamente 6-18% dos casos 4-7 .O sistema nervoso periférico é o menos acometido 4-7 , e não tem sido objeto de estudo. A incidência de drogas induzindo lesões de nervos periféricos é de difícil estabelecimento.

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Section: Resultsunclassified

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Investigação de neuropatia periférica durante o período recente do transplante de medula óssea

Zétola

Scola

Pasqüini

et al. 1998

Arq. Neuro-Psiquiatr.

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“…CIM has been reported in at least one third of ICU patients treated for status asthmaticus [8] and studies of critically ill patients suggest incidence rates between 12-35% [9][10][11][12]. Prospective studies suggest that CIP may occur in up to 50-70% of patients admitted to the ICU with a diagnosis of systemic inflammatory response syndrome (SIRS) [13][14][15]. In a recent systematic review of 24 studies reporting data for 1421 patients, the overall median prevalence of NMD was 46% (95% confidence interval 43-49%) in adult subjects with either sepsis, multi-organ failure, or prolonged mechanical ventilation (median duration, 7 days) [7].…”

Section: Incidence Of Acquired Neuromuscular Dysfunction In the Icumentioning

confidence: 99%

“…Sepsis and SIRS has been associated with NMD in a number of prospective studies [14,15,[21][22][23]. Severity of critical illness and organ dysfunction scores predicts NMD in multivariable analyses.…”

Section: Risk Factors For Acquired Neuromuscular Weaknessmentioning

confidence: 99%

“…A high prevalence of long-term functional limitations was reported in ICU survivors with CIP [37]. In the first prospective study of CIP, sepsis survivors with mild-to-moderately severe neuropathy recovered over a period of months, while patients with severe neuropathy had more protracted clinical deficits or no recovery [14]. It might be expected that functional outcome in CIP would be determined by the extent of axonal degeneration: recovery of strength is dependent upon axonal regeneration so recovery would be expected to occur in proximal muscle groups before distal muscle groups [33].…”

Section: Prognosis Of Icu-acquired Nmdmentioning

confidence: 99%

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Mechanisms of Neuromuscular Dysfunction in Critical Illness

Khan

Harrison

Rich

2008

Critical Care Clinics

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The development of neuromuscular dysfunction (NMD) during critical illness is increasingly recognized as a cause of failure to wean from mechanical ventilation and is associated with significant morbidity and mortality. At times it is difficult to identify the presence of NMD and distinguish the etiology of the weakness in patients with critical illness, but subtle clinical findings and bedside electrophysiological testing are helpful in establishing the diagnosis. The purpose of this review is to describe the clinical spectrum of acquired neuromuscular weakness in the setting of critical illness, provide an approach to diagnosis, and to discuss its pathogenesis. Finally, we propose defective sodium channel regulation as a unifying mechanism underlying NMD in critically ill patients.

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Hemiparetic Acute Myopathy of Intensive Care Progressing to Triplegia

Sun¹,

Edgar²,

Rubin³

1997

Archives of Neurology

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This case demonstrates that high-dose corticosteroid therapy can induce asymmetrical myopathic weakness. Hemiplegia evolving to triplegia in a setting of corticosteroid treatment could potentially misdirect the diagnosis toward a lesion of the brain or spinal cord. When a central nervous system abnormality cannot be demonstrated a search for a peripheral abnormality, such as myopathy, is warranted.

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Peripheral Nerve Function in Sepsis and Multiple Organ Failure

Cited by 507 publications

References 30 publications

Investigação de neuropatia periférica durante o período recente do transplante de medula óssea

Investigação de neuropatia periférica durante o período recente do transplante de medula óssea

Mechanisms of Neuromuscular Dysfunction in Critical Illness

Hemiparetic Acute Myopathy of Intensive Care Progressing to Triplegia

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