Risk factors for critical illness polyneuromyopathy

Bednařík, Josef; Vondráček, Petr; Dušek, Ladislav; Moravcova, Eva; Čundrle, Ivan

doi:10.1007/s00415-005-0654-x

Cited by 172 publications

(162 citation statements)

References 41 publications

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“…Eleven out of the 29 (38%) 25,28,29,32,[36][37][38][39][40][41][42] observational studies were graded of low quality, 17 out of 29 (59%) 12,[14][15][16]20,24,26,27,30,[43][44][45][46][47][48][49][50] as medium and one (3%) 51 as high quality. There were four RCTs included; two studies were deemed of low risk, 22,23 one unclear risk 8 and one with high risk 31 of bias.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

The incidence of intensive care unit-acquired weakness syndromes: A systematic review

Appleton

Kinsella

Quasim

2014

Journal of the Intensive Care Society

150

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We conducted a literature review of the intensive care unit-acquired weakness syndromes (critical illness polyneuropathy, critical illness myopathy and critical illness neuromyopathy) with the primary objective of determining their incidence as a combined group. Studies were identified through MEDLINE, Embase, Cochrane Database and article reference list searches and were included if they evaluated the incidence of one or more of these conditions in an adult intensive care unit population. The incidence of an intensive care unit-acquired weakness syndrome in the included studies was 40% (1080/2686 patients, 95% confidence interval 38-42%). The intensive care unit populations included were heterogeneous though largely included patients receiving mechanical ventilation for seven or more days. Additional prespecified outcomes identified that the incidence of intensive care unit-acquired weakness varied with the diagnostic technique used, being lower with clinical (413/1276, 32%, 95% CI 30-35%) compared to electrophysiological techniques (749/1591, 47%, 95% CI 45-50%). Approximately a quarter of patients were not able to comply with clinical evaluation and this may be responsible for potential underreporting of this condition.

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Section: Quality Of Included Studiesmentioning

confidence: 99%

The incidence of intensive care unit-acquired weakness syndromes: A systematic review

Appleton

Kinsella

Quasim

2014

Journal of the Intensive Care Society

150

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“…These studies, however, did not adjust for confounding variables that might associate with the development of NMD and, in fact, many of these same patients with ICU weakness had sepsis, multi-organ dysfunction (MOD), or organ rejection. Further prospective studies subsequently found no association between NMD and either steroids or neuromuscular blockade [9,10,24], although in one report corticosteroid administration was associated with NMD in multivariate analysis (OR 14.9, 95% CI 3.2-69.8, p <0.001) [21].…”

Section: Risk Factors For Acquired Neuromuscular Weaknessmentioning

confidence: 94%

“…Alternate terms include ICU-acquired paresis, critical illness neuromyopathy, and critical illness neuromuscular abnormalities. 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].…”

Section: Incidence Of Acquired Neuromuscular Dysfunction In the Icumentioning

confidence: 99%

“…A prospective multicenter study of 95 patients mechanically ventilated for 7 or more days reported that the number of days with organ dysfunction of ≥2 organs significantly predicted NMD in multivariable analysis [21]. Duration of SIRS and severity of organ dysfunction also predict NMD: approximately 86% of NMD subjects had >3days days with SIRS) and cumulative 1-weeks SOFA score >45 [9].…”

Section: Risk Factors For Acquired Neuromuscular Weaknessmentioning

confidence: 99%

“…However, recently it has been recognized that the two syndromes often coexist [9,18,19,62]. CIP and CIM could occur together either because they are distinct syndromes that are due to coexisting risk factors or because they represent different manifestations of a single underlying disorder.…”

Section: Inexcitability Of Sd Muscle Is Due To Abnormal Regulation Ofmentioning

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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Interventions for preventing critical illness polyneuropathy and critical illness myopathy

Hermans¹,

Jonghe²,

Bruyninckx³

et al. 2007

Cochrane Database of Systematic Reviews

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Background Critical illness polyneuropathy or myopathy (CIP/CIM) is a frequent complication in the intensive care unit (ICU) and is associated with prolonged mechanical ventilation, longer ICU stay and increased mortality. This is an interim update of a review first published in 2009 (Hermans 2009). It has been updated to October 2011, with further potentially eligible studies from a December 2013 search characterised as awaiting assessment. Objectives To systematically review the evidence from RCTs concerning the ability of any intervention to reduce the incidence of CIP or CIM in critically ill individuals. Search methods On 4 October 2011, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, and EMBASE. We checked the bibliographies of identified trials and contacted trial authors and experts in the field. We carried out an additional search of these databases on 6 December 2013 to identify recent studies. Selection criteria All randomised controlled trials (RCTs), examining the effect of any intervention on the incidence of CIP/CIM in people admitted to adult medical or surgical ICUs. The primary outcome was the incidence of CIP/CIM in ICU, based on electrophysiological or clinical examination. Secondary outcomes included duration of mechanical ventilation, duration of ICU stay, death at 30 and 180 days after ICU admission and serious adverse events from the treatment regimens.

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Risk factors for critical illness polyneuromyopathy

Cited by 172 publications

References 41 publications

The incidence of intensive care unit-acquired weakness syndromes: A systematic review

The incidence of intensive care unit-acquired weakness syndromes: A systematic review

Mechanisms of Neuromuscular Dysfunction in Critical Illness

Interventions for preventing critical illness polyneuropathy and critical illness myopathy

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