The Role of Polyneuropathy in Motor Convalescence After Prolonged Mechanical Ventilation

Leijten, Frans S.S.; Weerd, J. E. Harinck-De; Poortvliet, D.C.J.; Weerd, A.W. de

doi:10.1001/jama.1995.03530150045032

Cited by 256 publications

(177 citation statements)

References 23 publications

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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%

“…Prospective studies in patients ventilated for over seven days have reported increased hospital mortality associated with NMD [13,15,24]. In fact, the development of NMD early in the course of critical illness may predict mortality.…”

Section: Prognosis Of Icu-acquired Nmdmentioning

confidence: 99%

“…The presence of NMD is also associated with clinically significant short and long-term morbidity. Both CIM and CIP are associated with prolonged duration of mechanical ventilation and increased length of hospital and ICU stay [13,15,35]. Thus the presence of acquired paresis can inform the clinical decision to pursue early tracheostomy and arrange for long-term care after hospital discharge.…”

Section: Prognosis Of Icu-acquired Nmdmentioning

confidence: 99%

“…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]. In a prospective community ICU study including patients with > 7 days of mechanical ventilation, it was found that although sensory and motor deficits associated with CIP improved with time, severe functional deficits persisted at one year after ICU discharge in 22% of all 1-year survivors [13]. In another study of patients who survived longer than 4 weeks of critical illness, some continued to have evidence of clinical weakness and electrophysiologic evidence of neuropathy up to 4 years after hospitalization [34].…”

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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Section: Incidence Of Acquired Neuromuscular Dysfunction In the Icumentioning

confidence: 99%

Section: Prognosis Of Icu-acquired Nmdmentioning

confidence: 99%

Section: Prognosis Of Icu-acquired Nmdmentioning

confidence: 99%

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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“…In subpopulations in which sepsis is complicated by multiple organ failure (MOF), the incidence rates of CIP and CIM could even reach 100% [20]. Approximately two-thirds of patients with ARDS exhibit these neuromuscular disorders [21], and in unselected patients that have required mechanical ventilation for at least 4 days, the incidence rates of CIP and CIM range from 25 to 33% on clinical evaluation, and can reach 58% on electrophysiological evaluation [4,17]. Furthermore, 49-77% of patients will have ICUAW when treated in an ICU for ≥7 days [22,23].…”

Section: Introductionmentioning

confidence: 99%

Skeletal Muscle Dysfunction in Critical Illness

Iida¹,

Sakuma²

2017

Physical Disabilities - Therapeutic Implications

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Despite improvements in critical illness survival rates with recent developments in medical care, many patients still have long-term physical disabilities following stays in the intensive care unit (ICU). Critical illness-induced muscle weakness, so-called ICU-acquired weakness (ICU-AW), is a common occurrence in approximately 50% of critically ill patients in the ICU requiring mechanical ventilation for >7 days. ICU-AW contributes to increases in duration of mechanical ventilation and lengths of ICU and hospital stays and may persist among survivors for several years after discharge. Risk factors for ICU-AW include systemic inflammatory responses, severe sepsis, muscle inactivity, hyperglycemia, and use of neuromuscular blockers. Thus, the development of muscle wasting is suggested to be associated with pathophysiological alterations leading to an imbalance between muscle proteolysis and proteosynthesis through several cellular signaling networks. This chapter presents a review of the literature regarding critical illness-induced muscle wasting and describes potential treatment of excessive muscle catabolism.

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