Neuromuscular Disorders in the Intensive Care Unit

Abstract

PURPOSE OF REVIEW This article discusses the pathophysiology, presentation, diagnosis, treatment, and prognosis of common neuromuscular disorders seen in the intensive care unit, including Guillain-Barré syndrome, myasthenia gravis, and intensive care unit–acquired weakness. RECENT FINDINGS Guillain-Barré syndrome can have an excellent prognosis if patients are diagnosed early, appropriately treated, and monitored for complications, including respiratory failure and dysautonomia. Intensive care unit–acquired weakness increases overall mortality in patients who are critically ill, and distinguishing between critical illness myopathy and critical illness polyneuropathy may have important prognostic implications. SUMMARY Neuromuscular disorders are not rare in the intensive care unit setting, and precise identification and treatment of these conditions can greatly impact long-term outcomes.

Our Clinical Experience in the Treatment of Myasthenia Gravis Acute Exacerbations with a Novel Nanomembrane-Based Therapeutic Plasma Exchange Technology

“…Our secondary outcomes ( Table 4 ) support the role of TPE for early extubation (≤7 days) as well as the role of NIV for decreasing ventilation duration (≤7 days) reported by others [ 9 , 26 ]. Our findings also suggest that older age, higher MGFA class on admission, and late-onset MG ( Table 2 , Figure 1 ) increase the risk of long-term ventilation, which is line with the findings reported by others [ 5 , 27 ]. Conversely, our results concerning predominantly male sex and late-onset MG non-responders (with response in the context of lower MMS scores) do not support the findings from another retrospective study, where the patients with male sex and late-onset MG were associated with a better response (with response in the context of complete resolution without need for maintenance TPE) [ 28 ].…”

“…However, our preliminary results suggest that TPE could focus our efforts on weaning patients off of mechanical ventilation rather than early tracheotomy. Aggressive management of myasthenia gravis (e.g., TPE) may enhance muscle strength and facilitate early extubation [ 27 ].…”

“…Aggressive management of myasthenia gravis (e.g., TPE) may enhance muscle strength and facilitate early extubation [27].…”