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Critical illness myopathy is frequent: accompanying neuropathy protracts ICU discharge

Item Type:Article
Title:Critical illness myopathy is frequent: accompanying neuropathy protracts ICU discharge
Creators Name:Koch, S. and Spuler, S. and Deja, M. and Bierbrauer, J. and Dimroth, A. and Behse, F. and Spies, C.D. and Wernecke, K.D. and Weber-Carstens, S.
Abstract:Objectives Neuromuscular dysfunction in critically ill patients is attributed to either critical illness myopathy (CIM) or critical illness polyneuropathy (CIP) or a combination of both. However, it is unknown whether differential diagnosis has an impact on prognosis. This study investigates whether there is an association between the early differentiation of CIM versus CIP and clinical prognosis. Methods The authors included mechanically ventilated patients who featured a Simplified Acute Physiology Score II (SAPS-II) >/=20 on three consecutive days within the first week after intensive care unit (ICU) admission. Fifty-three critically ill patients were enrolled and examined by conventional nerve-conduction studies and direct muscle stimulation (184 examinations in total). The first examination was conducted within the first week after admission to the ICU. Results In this cohort of critically ill patients, CIM was more frequent (68%) than CIP (38%). Electrophysiological signs of CIM preceded electrophysiological signs of CIP (median at day 7 in CIM patients vs day 10 in CIP patients, p<0.001). Most patients with CIP featured concomitant CIM. At discharge from ICU, 25% of patients with isolated CIM showed electrophysiological signs of recovery and significantly lower degrees of weakness. Recovery could not be observed in patients with combined CIM/CIP, even though the ICU length of stay was significantly longer (mean 35 days in CIM/CIP vs mean 19 days in CIM, p<0.001). Conclusion Prognoses of patients differ depending on electrophysiological findings during early critical illness: early electrophysiological differentiation of ICU acquired neuromuscular disorder enhances the evaluation of clinical prognosis during critical illness.
Keywords:Action Potentials, Artificial Respiration, Critical Illness, Electromyography, Intensive Care Units, Kaplan-Meier Estimate, Length of Stay, Muscular Atrophy, Neural Conduction, Polyneuropathies, Proportional Hazards Models, Severity of Illness Index, Skeletal Muscle
Source:Journal of Neurology Neurosurgery and Psychiatry
Publisher:BMJ Publishing Group
Page Range:287-293
Date:March 2011
Official Publication:https://doi.org/10.1136/jnnp.2009.192997
PubMed:View item in PubMed

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