Electrodiagnostic findings in patients with non‐COVID‐19‐ and COVID‐19‐related acute respiratory distress syndrome

Abstract

Background Critical illness polyneuropathy and myopathy (CIPNM) is a frequent neurological manifestation in patients with acute respiratory distress syndrome (ARDS) from coronavirus disease 2019 (COVID‐19) infection. CIPNM diagnosis is usually limited to clinical evaluation. We compared patients with ARDS from COVID‐19 and other aetiologies, in whom a neurophysiological evaluation for the detection of CIPNM was performed. The aim was to determine if there were any differences between these two groups in frequency of CINPM and outcome at discharge from the intensive care unit (ICU). Materials and Methods This was a single‐centre retrospective study performed on mechanically ventilated patients consecutively admitted (January 2016‐June 2020) to the ICU of Careggi Hospital, Florence, Italy, with ARDS of different aetiologies. Neurophysiological evaluation was performed on patients with stable ventilation parameters, but marked widespread hyposthenia (Medical Research Council score <48). Creatine phosphokinase (CPK), lactic dehydrogenase (LDH) and mean morning glycaemic values were collected. Results From a total of 148 patients, 23 with COVID‐19 infection and 21 with ARDS due to other aetiologies, underwent electroneurography/electromyography (ENG/EMG) recording. Incidence of CIPNM was similar in the two groups, 65% (15 of 23) in COVID‐19 patients and 71% (15 of 21) in patients affected by ARDS of other aetiologies. At ICU discharge, subjects with CIPNM more frequently required ventilatory support, regardless the aetiology of ARDS. Conclusion ENG/EMG represents a useful tool in the identification of the neuromuscular causes underlying ventilator wean failure and patient stratification. A high incidence of CIPNM, with a similar percentage, has been observed in ARDS patients of all aetiologies.

Das ist neu in der Neurointensiv- und Notfallmedizin: die wichtigsten Studien des Jahres im Rück- und Überblick

“…Obwohl es intensivmedizinisch durch eine Coronavirus-disease-19(COVID-19)-Erkrankung häufig zu prolongierten Verläufen mit einer langen Beatmungsnotwendigkeit kommt, ist die Critical-illness-Polyneuropathie-Myopathie (CIPNM) nur unzureichend in diesem Patientenkollektiv untersucht. Patienten mit einem „acute respiratory distress syndrome“ (ARDS) allein ( n = 21) und ARDS aufgrund einer COVID-19-Infektion ( n = 23) wiesen keine unterschiedliche Inzidenz der CIPNM in dieser neurophysiologisch gut aufgearbeiteten Kohorte auf [ 23 ]. In einer anderen Studie wurden neurophysiologische Untersuchungen und Serumbiomarker verglichen zwischen COVID-Patienten, die keine oder eine CIPNM entwickelten [ 8 ].…”

Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

“…Regarding ICU complications, there were no differences in the rates of muscular weakness, cardiovascular and abdominal complications, data consistent with the literature. ( 40 )…”

Acquired brain injuries: neurophysiology in early prognosis and rehabilitation pathway

“…Concerning neuromuscular disorders, some neurophysiological parameters, such as nerve conduction (electroneurography-ENG) and electromyography (EMG), for the evaluation of spontaneous activity, have been used for CIPNM detection in critically ill patients [13,21,47]. The authors showed that the presence of CIPNM may prolong recovery time in IRUs, worsen the final outcome and increase the cost of hospitalisation [54,55].…”