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Critical-Illness-Polyneuropathie und Critical-Illness-Myopathie

Critical illness polyneuropathy and critical illness myopathy

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Zusammenfassung

„Critical illness polyneuropathy“ (CIP) und „critical illness myopathy“ (CIM) sind häufige Komplikationen einer schweren Erkrankung, insbesondere Sepsis, SIRS (systemisches inflammatorisches Response-Syndrom) und Multiorganversagen. Hauptsymptome sind die muskuläre Schwäche und Probleme bei der Entwöhnung von der Beatmung. CIP und CIM führen zu verlängerten Beatmungszeiten, längeren Aufenthalten in Klinik- und Rehabilitationseinrichtungen und zu einer erhöhten Mortalität. Elektrophysiologische Messungen können beide Entitäten relativ früh im Verlauf der Erkrankung nachweisen. Eine frühe leitliniengerechte Sepsistherapie ist das wichtigste Instrument, die Entwicklung einer CIP oder CIM zu vermeiden. Obwohl zurzeit keine spezifische Therapie für CIP und CIM bekannt ist, verbessert die Diagnose das therapeutische Management (Entwöhnung von der Beatmung, frühe Physiotherapie, etc.). Der Beitrag gibt eine Übersicht über die klinischen und diagnostischen Zeichen von CIP und CIM und umreißt aktuelle pathophysiologische und therapeutische Konzepte.

Abstract

Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) are frequent complications in critically ill patients and both are associated with sepsis, systemic inflammatory response syndrome (SIRS) and multiorgan failure. Major signs are muscle weakness and problems of weaning from the ventilator. Both CIP and CIM lead to elongated times of ventilation, elongated hospital stay, elongated times of rehabilitation and increased mortality. Electrophysiological measurements help to detect CIP and CIM early in the course of the disease. State of the art sepsis therapy is the major target to prevent the development of CIP and CIM. Although no specific therapy of CIP and CIM has been established in the past, the diagnosis generally improves the therapeutic management (weaning from the ventilator, early physiotherapy, etc.). 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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Danksagung

Diese Arbeit wurden durch das Bundesministerium für Bildung und Forschung (BMBF), FKZ: 01EO1002, gefördert.

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Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Hans Berger Klinik für Neurologie, Integriertes Forschungs- und Behandlungszentrum „Sepsis und Sepsisfolgen“ (CSCC), Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland

    A. Grimm, A. Günther, O.W. Witte &  H. Axer

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  1. A. Grimm
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  2. A. Günther
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  3. O.W. Witte
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  4. H. Axer
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Correspondence to H. Axer.

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Grimm, A., Günther, A., Witte, O. et al. Critical-Illness-Polyneuropathie und Critical-Illness-Myopathie . Med Klin Intensivmed Notfmed 107, 649–660 (2012). https://doi.org/10.1007/s00063-012-0186-y

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  • DOI: https://doi.org/10.1007/s00063-012-0186-y

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