Critical illness polyneuropathy in multiple organ dysfunction syndrome and weaning from the ventilator

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

doi:10.1007/bf02044107

Cited by 166 publications

(27 citation statements)

References 39 publications

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“…Confirmed risk factors for CIP are sepsis, SIRS and MOF [7, 11, 18–20]. CRP, a marker for SIRS [21] and sepsis [22, 23], were increased in nearly all cases of the present study, indicating systemic inflammation.…”

Section: Discussionsupporting

confidence: 61%

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Critical illness polyneuropathy (CIP) in neurological early rehabilitation: clinical and neurophysiological features

Schmidt

Rollnik

2016

BMC Neurol

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BackgroundCritical illness polyneuropathy (CIP) is a complex disease affecting 30–70% of critically ill patients.MethodsClinical (Barthel index, length of stay (LOS), morbidity, duration of mechanical ventilation, routine lab results) and neurophysiological (neurography) data of 191 patients admitted to neurological early rehabilitation and diagnosed with CIP have been analyzed retrospectively.ResultsCIP diagnosis was correct in 159 cases (83%). In this study, systemic inflammation, sepsis, systemic inflammatory response syndrome (SIRS), multiple organic failure (MOF), chronic renal failure, liver dysfunction, mechanical ventilation, diabetes, dyslipidemia and impaired ion homeostasis (hypocalcaemia, hypokalemia) were associated with CIP. Neurography, in particular of the peroneal, sural, tibial and median nerves, helped to identify CIP patients. Compound muscle action potential amplitude (r = −0.324, p < 0.05), as well as sensory (r = −0.389, p < 0.05) and motor conduction velocity (r = −0.347, p < 0.05) of the median nerve correlated with LOS in neurological early rehabilitation but not with outcome measures.ConclusionsIn most cases, diagnosis of CIP among neurological early rehabilitation patients seems to be correct. Neurography may help to verify the diagnosis and to learn more about CIP pathophysiology, but it does not allow outcome prediction. Further studies on CIP are strongly encouraged.

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Section: Discussionsupporting

confidence: 61%

“…It is known that mechanical ventilation is associated with CIP [9, 18]. In this study, 79% of all patients had been on mechanical ventilation before or during early rehabilitation.…”

Section: Discussionmentioning

confidence: 93%

Critical illness polyneuropathy (CIP) in neurological early rehabilitation: clinical and neurophysiological features

Schmidt

Rollnik

2016

BMC Neurol

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“…Some investigators have observed a significantly higher mortality in patients with CIP compared to patients in the ICU with similar APACHE III scores but who did not have neuropathy Table 4 Features of critical illness polyneuropathy. Neurocritical Care ♦ Volume 3, 2005 (172,176,178) ; however, this finding has not been confirmed by others (35) . A prospective study of 73 patients with sepsis demonstrated that patients with CIP required ventilator support for an additional 12 days (median value), remained in the ICU an additional 19 days, and remained in the hospital an additional 52 days compared to patients without neuropathy (178) .…”

Section: Critical Illness Polyneuropathymentioning

confidence: 70%

“…Older studies have found a strong correlation between the severity of the neuropathy and duration of ventilator dependence, severity of multi-organ failure, and number of different organs involved (35,172,176) . However, others have found no correlation between electrophysiological abnormalities and length of stay in the ICU or time on the ventilator.…”

Section: Critical Illness Polyneuropathymentioning

confidence: 99%

“…(177) . Some researchers have suggested that the peripheral nervous system is simply another organ involved in patients in the ICU with multiple organ dysfunction syndrome (31,169,176) . Some investigators have observed a significantly higher mortality in patients with CIP compared to patients in the ICU with similar APACHE III scores but who did not have neuropathy Table 4 Features of critical illness polyneuropathy.…”

Section: Critical Illness Polyneuropathymentioning

confidence: 99%

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Approach to Neuromuscular Disorders in the Intensive Care Unit

Gorson

2005

NCC

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Neuromuscular disorders increasingly are recognized as a complication in patients in the intensive care unit (ICU) and represent a common cause of prolonged ventilator dependency. The distinct syndromes of critical illness myopathy, prolonged neuromuscular blockade, and critical illness polyneuropathy (CIP) may arise as a consequence of sepsis, multi-organ failure, and exposure to various medications--notably, intravenous corticosteroids and neuromuscular blocking agents--but the pathophysiology of these disorders remains poorly understood. More than one syndrome may occur simultaneously, and the distinctions may be difficult in a particular patient, but a specific diagnosis usually can be established after careful clinical, electrodiagnostic, and, when necessary, histological evaluation. For example, asthmatics requiring treatment with corticosteroids and neuromuscular blocking agents may develop an acute myopathy characterized by generalized weakness, preserved eye movements, elevated creatine kinase levels, and myopathic motor units on electromyography (EMG). Muscle biopsy demonstrates distinctive features of thick (myosin) filament loss on ultrastructural studies. Conversely, those with a prolonged ICU course that is complicated by episodes of sepsis with failure to wean from the ventilator, distal or generalized flaccid limb weakness, and areflexia probably have CIP. EMG in these patients demonstrates reduced or absent motor and sensory potentials with neurogenic motor units. Prolonged neuromuscular blockade most commonly occurs in patients with renal failure who have received prolonged infusions of neuromuscular blockers. There is severe flaccid, areflexic paralysis with normal sensation, facial weakness, and ophthalmoparesis that persists for days or weeks after the neuromuscular blockers have been discontinued. Repetitive nerve stimulation shows a decrement of the compound muscle action potential and, in most cases, establishes a disorder of neuromuscular transmission. With the recent epidemic of West Nile virus infection, a clinical syndrome of acute flaccid paralysis with several features indistinguishable from poliomyelitis has emerged. This article critically examines the clinical, electrophysiological, and pathological features of these and other acute neuromuscular syndromes that arise in the context of ICU care and summarizes the current understanding of the pathophysiology and treatment of these disorders.

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Paresis Acquired in the Intensive Care Unit<SUBTITLE>A Prospective Multicenter Study</SUBTITLE>

Jonghe

Sharshar²,

Lefaucheur³

et al. 2002

JAMA

1,343

937

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Critical illness polyneuropathy in multiple organ dysfunction syndrome and weaning from the ventilator

Abstract: Axonal polyneuropathy is related to the severity of multiple-organ-dysfunction syndrome. Its presence does not necessarily implicate difficult weaning from artificial ventilation.

Cited by 166 publications

References 39 publications

Critical illness polyneuropathy (CIP) in neurological early rehabilitation: clinical and neurophysiological features

Critical illness polyneuropathy (CIP) in neurological early rehabilitation: clinical and neurophysiological features

Approach to Neuromuscular Disorders in the Intensive Care Unit

Paresis Acquired in the Intensive Care Unit<SUBTITLE>A Prospective Multicenter Study</SUBTITLE>

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