Critical-illness-Myopathie und -Neuropathie (CRIMYN)

Abstract

A total of four different clusters of electrophysiological impairment can be identified in patients with sepsis/SIRS, which enables further differentiation of the severity of neuromuscular disturbances in sepsis-associated organ failure. This might be useful as a prognostic parameter and can be correlated with additional clinical and paraclinical parameters related to sepsis.

Intensive Care Unit Acquired Weakness (ICU-AW): a brief and practical review

“…The reduction in amplitude often precedes clinical presentation and accompanying fibrillation potentials and positive sharp waves that may occur in the second or third week ( Figure 1) [43]. The duration of CMAPs is an important indicator of CIM, and it accompanies the fall in amplitude [43]. CMAP duration can be 2-3 times longer compared to healthy controls and is most pronounced in lower limb nerves (Figure 2).…”

“…Abnormal SNAPs are characteristic for CIP, although local edema may interfere with optimal sensory nerve stimulation and recording. CIM is characterized by significant slowing of the muscle fiber conduction velocity or even muscle fiber conduction block during the acute phase, which correlates with a prolonged CMAP duration and altered muscle fiber excitability [43]. The earliest electrophysiological sign of CIP is a reduction of CMAP amplitudes, with a minor change in latency.…”

“…They are patients treated with high doses of nondepolarizing neuromuscular blocking agents such as vecuronium and pancuronium may have persistent weakness and fail weaning from the ventilator, even after the blocking drugs have been discontinued [43,49]. Examination shows generalized weakness, normal or reduced reflexes, and normal sensation.…”

“…A reduction in the amplitude of compound muscle action potentials (CMAP) or sensory nerve action potentials (SNAP), or both, with preserved conduction velocity and normal distal motor latencies, in addition to normal responses to repetitive nerve stimulation, may be seen within 2-5 days after the onset of symptoms. The reduction in amplitude often precedes clinical presentation and accompanying fibrillation potentials and positive sharp waves that may occur in the second or third week ( Figure 1) [43]. The duration of CMAPs is an important indicator of CIM, and it accompanies the fall in amplitude [43].…”

“…Examination shows generalized weakness, normal or reduced reflexes, and normal sensation. Bilateral ptosis and facial and jaw muscle Intensive Care Unit Acquired Weakness (ICU-AW): a brief and practical review weakness may be present [43]. Electrophysiologic features are reduced CMAP amplitude and decrementing the response on 2-3 Hz repetitive nerve stimulation (Figure 4).…”