Critical illness polyneuromyopathy: the electrophysiological components of a complex entity

Bednařík, Josef; Lukáš, Zdeněk; Vondráček, Petr

doi:10.1007/s00134-003-1858-0

Cited by 175 publications

(165 citation statements)

References 32 publications

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“…A clear correlation between motor electrophysiology and histopathological abnormalities could not be demonstrated in all studies [28,29]. Morphological changes in CIP can be seen in nerve biopsies e.g.…”

Section: Diagnostic Featuresmentioning

confidence: 84%

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Neurological Sequelae of Sepsis: II) Neuromuscular Weakness

Axer¹

2011

TOCCMJ

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Abstract:Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) have been established as separate entities of muscular weakness in critically ill patients, although both may be associated to each other in some respects. Both are associated to systemic inflammatory response syndrome, sepsis, and severe sepsis. Major signs of nerve and muscle disturbances in critically ill patients are muscle weakness and problems of weaning from the ventilator. Electroneurographic measurements help to detect CIP early in the course of the disease, while muscle biopsy seems to date the diagnostic tool of choice to detect CIM. Sepsis therapy is the major target to prevent the development of CIP and CIM. However, no specific therapy of CIP and CIM has been established in the past. Therefore, management of patients with CIP and CIM is mainly supportive. Neuromuscular weakness cause elongated times of ventilation, elongated hospital stay, elongated times of rehabilitation, and increased mortality. This review provides an overview of clinical and diagnostic features of CIP and CIM, and summarizes current pathophysiological and therapeutic concepts.

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Section: Diagnostic Featuresmentioning

confidence: 84%

“…CIP and CIM may coexist and their relative contribution to the weakness may vary [24]. Thus, many clinicians suggest to consider it as a complex entity of polyneuromyopathy [29]. Recognizing CIP or CIM often improves management, although no specific pharmacologic treatments are known at present [91].…”

Section: Conclusive Remarksmentioning

confidence: 99%

Neurological Sequelae of Sepsis: II) Neuromuscular Weakness

Axer¹

2011

TOCCMJ

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“…It was later suggested that neuropathy and myopathy might be acquired in tandem during critical illness [17]. Multiple prospective studies subsequently reported combined myopathic and neuropathic findings in individual patients on the basis of either electrophysiologic or biopsy specimens [12,18,19]. Data allowing for specific classification of NMD revealed similar proportions of patients diagnosed with CIM (49/144, 34%), CIP (51/144, 35%), and combined CIM/CIP (44/144, 30.6%) [7].…”

Section: Incidence Of Acquired Neuromuscular Dysfunction In the Icumentioning

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%

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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“…Therefore, it is difficult to accurately determine the incidence rates of CIP and CIM [12,16,17]. Intriguingly, recent data suggest that CIP and CIM frequently coexist, a condition that has been termed CINM [18]. The pathophysiology of CINM/ICUAW is complex and includes the sequelae of bed rest, the effects of critical illness-induced cytokine production, and possibly the interplay of drugs, such as neuromuscular blocking agents and corticosteroids (Figure 1).…”

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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Critical illness polyneuromyopathy: the electrophysiological components of a complex entity

Cited by 175 publications

References 32 publications

Neurological Sequelae of Sepsis: II) Neuromuscular Weakness

Neurological Sequelae of Sepsis: II) Neuromuscular Weakness

Mechanisms of Neuromuscular Dysfunction in Critical Illness

Skeletal Muscle Dysfunction in Critical Illness

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