Skip to main content
SpringerLink
Log in

Acute Neuromuscular Weakness in the Intensive Care Unit

  • Chapter
  • First Online:
Neuromuscular Disorders in Clinical Practice

  • 5861 Accesses

Abstract

Acute neuromuscular weakness in the intensive care unit is increasingly recognized. This is often caused by one the following disorders: critical illness myopathy, critical illness polyneuropathy, and prolonged neuromuscular junction blockade. These three disorders are the focal points of this chapter which will relate their clinical, electrodiagnostic, and pathologic features as well as discuss pathogenesis and controversies. However, potential subgroups of the three major disorders and the differential diagnosis of weakness in the ICU patient are also discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 449.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Op de Coul AAW, Lambregts PC, Koeman J, et al. Neuromuscular complications in patients given Pavulon (pancuronium bromide) during artificial ventilation. Clin Neurol Neurosurg. 1985;87:17–22.

    Article  Google Scholar 

  2. Lacomis D, Petrella JT, Giuliani MJ. Causes of neuromuscular weakness in the intensive care unit: a study of 92 patients. Muscle Nerve. 1998;21:610–7.

    Article  PubMed  CAS  Google Scholar 

  3. Latronico N, Fenzi F, Recupero D, Guarneri B, Tomelleri G, Tonin P, et al. Critical illness myopathy and neuropathy. Lancet. 1996;347:1579–82.

    Article  PubMed  CAS  Google Scholar 

  4. Breuer AC. Critical illness polyneuropathy. An outdated concept. Muscle Nerve. 1999;22:422–4.

    Article  Google Scholar 

  5. Coakley JH, Yarwood GD, Hinds CJ. Patterns of neurophysiological abnormality in prolonged critical illness. Intensive Care Med. 1998;24:801–7.

    Article  PubMed  CAS  Google Scholar 

  6. De Jonghe B, Sharshar T, Lefaucheur JP, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288:2859–67.

    Article  PubMed  Google Scholar 

  7. Khan J, Harrison TB, Rich MM, et al. Early development of critical illness myopathy and neuropathy in patients with severe sepsis. Neurology. 2006;67:1421–5.

    Article  PubMed  Google Scholar 

  8. de Letter MA, Schmitz PI, Visser LH, et al. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med. 2001;29:2281–6.

    Article  PubMed  Google Scholar 

  9. Bednarik J, Vondracek P, Dusek L, et al. Risk factors for critical illness polyneuromyopathy. J Neurol. 2005;252:343–51.

    Article  PubMed  CAS  Google Scholar 

  10. Coakley JH, Nagendran K, Honavar M, et al. Preliminary observations on the neuromuscular abnormalities in patients with organ failure and sepsis. Intensive Care Med. 1993;19:323–8.

    Article  PubMed  CAS  Google Scholar 

  11. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:867–74.

    Google Scholar 

  12. Witt NJ, Zochodne DW, Bolton CF, Grand Maison F, Wells G, Young B, et al. Peripheral nerve function in sepsis and multiorgan failure. Chest. 1991;99:176–84.

    Article  PubMed  CAS  Google Scholar 

  13. Bolton CF, Young GB, Zochodne DW. The neurological complications of sepsis. Ann Neurol. 1993;33:94–100.

    Article  PubMed  CAS  Google Scholar 

  14. Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ. Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry. 1984;47:1223–31.

    Article  PubMed  CAS  Google Scholar 

  15. Zochodne DW, Bolton CF, Wells GA, Gilbert JJ, Hahn AF, Brown JD, et al. Critical illness polyneuropathy. A complication of sepsis and multiple organ failure. Brain. 1987;110:819–42.

    Article  PubMed  Google Scholar 

  16. Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–61.

    Article  PubMed  Google Scholar 

  17. Hermans G, Wilmer A, Meersseman W, et al. Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. Am J Respir Crit Care Med. 2007;175:480–9.

    Article  PubMed  CAS  Google Scholar 

  18. Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359–67.

    Article  PubMed  Google Scholar 

  19. Van den Berghe G, Schoonheydt K, Becx P, et al. Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology. 2005;64:1348–53.

    Article  PubMed  CAS  Google Scholar 

  20. The NICE-SUGAR Study Investigators. Intensive versus ­conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.

    Article  Google Scholar 

  21. Bolton CF. Critical illness polyneuropathy. A useful concept. Muscle Nerve. 1999;22:419–22.

    Article  PubMed  CAS  Google Scholar 

  22. Lacomis D, Giuliani MJ, Van Cott A, Kramer DJ. Acute myopathy of intensive care: clinical, EMG, and pathologic aspects. Ann Neurol. 1996;40:645–54.

    Article  PubMed  CAS  Google Scholar 

  23. MacFarlane LA, Rosenthal FD. Severe myopathy after status ­asthmaticus. Lancet. 1977;1:615.

    Article  Google Scholar 

  24. Apte-Kakade S. Rehabilitation of patients with quadriparesis after treatment of status asthmaticus with neuromuscular blocking agents and high-dose corticosteroids. Arch Phys Med Rehabil. 1991;72:1024–8.

    PubMed  CAS  Google Scholar 

  25. Van Marle W, Woods KL. Acute hydrocortisone myopathy. Br Med J. 1980;281:271–2.

    Article  PubMed  Google Scholar 

  26. Knox AJ, Mascie-Taylor BH, Muers MF. Acute hydrocortisone myopathy in acute severe asthma. Thorax. 1986;41:411–2.

    Article  PubMed  CAS  Google Scholar 

  27. Kaplan PW, Rocha W, Sanders DB, et al. Acute steroid-induced tetraplegia following status asthmaticus. Pediatrics. 1986;78:121–3.

    PubMed  CAS  Google Scholar 

  28. Bachmann P, Gassourges P, Piperno D, et al. Myopathies aigue au decors de Petat de mal asthmatique. Presse Med. 1987;16:1486.

    PubMed  CAS  Google Scholar 

  29. Williams TJ, O’Heir RE, Czarny D, Horne M, Bowers G. Acute myopathy in severe asthma treated with intravenously administered corticosteroids. Am Rev Respir Dis. 1988;137:460–3.

    Article  PubMed  CAS  Google Scholar 

  30. Sury MRJ, Russell GN, Heaf DP. Hydrocortisone myopathy. Lancet. 1988;2:515 (letter).

    Article  PubMed  CAS  Google Scholar 

  31. Brun-Buisson C, Gherardi R. Hydrocortisone and pancuronium bromide. Acute myopathy during status asthmaticus. Crit Care Med. 1988;16:731 (letter).

    Google Scholar 

  32. Shee CD. Risk factors for hydrocortisone myopathy in acute severe asthma. Respir Med. 1990;84:229–33.

    Article  PubMed  CAS  Google Scholar 

  33. Sitwell LD, Weinshenker BG, Monpetit V, Reid D. Complete ophthalmoplegia as a complication of acute corticosteroid- and pancuronium-associated myopathy. Neurology. 1991;41:921–2.

    Article  PubMed  CAS  Google Scholar 

  34. Danon MJ, Carpenter S. Myopathy with thick filament (myosin) loss following prolonged paralysis with vecuronium during steroid treatment. Muscle Nerve. 1991;14:1131–9.

    Article  PubMed  CAS  Google Scholar 

  35. De Smet Y, Jaminet M, Jaeger U, et al. Myopathie aigue cortisonique de l’asthmatique. Rev Neurol. 1991;147:682–5.

    PubMed  Google Scholar 

  36. Hirano M, Ott BR, Raps EC, et al. Acute quadriplegic myopathy: a complication of treatment with steroids, nondepolarizing blocking agents, or both. Neurology. 1992;42:2082–7.

    Article  PubMed  CAS  Google Scholar 

  37. Lacomis D, Smith TW, Chad DA. Acute myopathy and neuropathy in status asthmaticus: case report and literature review. Muscle Nerve. 1993;16:84–90.

    Article  PubMed  CAS  Google Scholar 

  38. Douglass JA, Tuxen DV, Horne M, et al. Myopathy in severe asthma. Am Rev Respir Dis. 1992;146:517–9.

    Article  PubMed  CAS  Google Scholar 

  39. Griffin D, Fairman N, Coursin D, et al. Acute myopathy during treatment of status asthmaticus with corticosteroids and steroidal muscle relaxants. Chest. 1992;102:510–4.

    Article  PubMed  CAS  Google Scholar 

  40. Waclawik AJ, Sufit RL, Beinlich BR, Schutta HS. Acute myopathy with selective degeneration of myosin thick filaments following status asthmaticus treated with methylprednisolone and vecuronium. Neuromuscul Disord. 1992;2:19–26.

    Article  PubMed  CAS  Google Scholar 

  41. Blackie JD, Gibson P, Murree-Allen K, et al. Acute myopathy in status asthmaticus. Clin Exp Neurol. 1993;30:72–80.

    PubMed  CAS  Google Scholar 

  42. Road J, Mackie G, Jiang T, Stewart H, Eisen A. Reversible paralysis with status asthmaticus, steroids, and pancuronium: clinical electrophysiological correlates. Muscle Nerve. 1997;20:1587–90.

    Article  PubMed  CAS  Google Scholar 

  43. Bella IR, Chad DA, Smith TW, et al. Ophthalmoplegia and quadriplegia in the wake of intensive therapy for status asthmaticus. Muscle Nerve. 1994;17:1122–3 (abstract).

    Google Scholar 

  44. Leatherman JW, Fluegel WL, David WS, Davied SF, Iber C. Muscle weakness in mechanically ventilated patients with severe asthma. Am J Respir Crit Care Med. 1996;153:1686–90.

    Article  PubMed  CAS  Google Scholar 

  45. Ramsay DA, Zochodne DW, Robertson DM, et al. A syndrome of acute severe muscle necrosis in intensive care unit patients. J Neuropathol Exp Neurol. 1993;52:387–98.

    Article  PubMed  CAS  Google Scholar 

  46. Gooch JL, Moore MH, Ryser DK. Prolonged paralysis after neuromuscular junction blockade: case reports and electrodiagnostic findings. Arch Phys Med Rehabil. 1993;74:1007–11.

    PubMed  CAS  Google Scholar 

  47. Zochodne DW, Ramsay DA, Saly V, Shelley S, Moffatt S. Acute necrotizing myopathy of intensive care: electrophysiological ­studies. Muscle Nerve. 1994;17:285–92.

    Article  PubMed  CAS  Google Scholar 

  48. Campellone JV, Lacomis D, Kramer DJ, Van Cott AC, Giuliani MJ. Acute myopathy after liver transplantation. Neurology. 1998;50:46–53.

    Article  PubMed  CAS  Google Scholar 

  49. Barohn RJ, Jackson CE, Rogers SJ, et al. Prolonged paralysis due to nondepolarizing neuromuscular blocking agents and corticosteroids. Muscle Nerve. 1994;17:647–54.

    Article  PubMed  CAS  Google Scholar 

  50. Subramony SH, Carpenter DE, Raju S, Pride M, Evans DB. Myopathy and prolonged neuromuscular blockade after lung ­transplant. Crit Care Med. 1991;19:1580–2.

    Article  PubMed  CAS  Google Scholar 

  51. Faragher MW, Day BJ, Dennett X. Critical care myopathy: an electrophysiological and histological study. Muscle Nerve. 1996;19:516–8.

    Article  PubMed  CAS  Google Scholar 

  52. Amaya-Villar R, Garnacho-Montero J, Garcia-Garmendia JL, et al. Steroid-induced myopathy in patients intubated due to exacerbation of chronic obstructive pulmonary disease. Intensive Care Med. 2005;31:157–61.

    Article  PubMed  Google Scholar 

  53. Hanson P, Dive A, Brucher J, Bisteau M, Dangoisse M, Deltombe T. Acute corticosteroid myopathy in intensive care patients. Muscle Nerve. 1997;20:1371–80.

    Article  PubMed  CAS  Google Scholar 

  54. Panegyres PK, Squier M, Mills KR, Newsom-Davis J. Acute myopathy associated with large parenteral dose of corticosteroid in myasthenia gravis. J Neurol Neurosurg Psychiatry. 1993;56:702–4.

    Article  PubMed  CAS  Google Scholar 

  55. Deconinck N, Van Parijs V, Beckers-Beckers-Bleukx G, Vanden Bergh PV. Critical illness myopathy unrelated to corticosteroids or neuromuscular blocking agents. Neuromuscul Disord. 1998;8:186–92.

    Article  PubMed  CAS  Google Scholar 

  56. Showalter CJ, Engel AG. Acute quadriplegic myopathy: analysis of myosin isoforms and evidence for calpain - mediated proteolysis. Muscle Nerve. 1997;20:316–22.

    Article  PubMed  CAS  Google Scholar 

  57. Tennilä A, Salmi T, Pettilä V. Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med. 2000;26:1360–3.

    Article  PubMed  Google Scholar 

  58. Hough CL, Steinberg KP, Thompson BT, et al. Intensive care unit-acquired neuromyopathy and corticosteroids in survivors of persistent ARDS. Intensive Care Med. 2009;35:63–8.

    Article  PubMed  CAS  Google Scholar 

  59. Weber-Carstens S, Deja M, Koch S, Spranger J, Bubser F, Wernecke KD, et al. Risk factors in critical illness myopathy during the early course of critical illness: a prospective observational study. Crit Care. 2010;14(3):R119.

    Article  PubMed  Google Scholar 

  60. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE-II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.

    Article  PubMed  CAS  Google Scholar 

  61. Pascuzzi RM. Drugs and toxins associated with myopathies. Curr Opin Rheumatol. 1998;10:511–20.

    Article  PubMed  CAS  Google Scholar 

  62. Hanna JP, Ramundo ML. Rhabdomyolysis and hypoxia associated with prolonged propofol infusion in children. Neurology. 1998;50:301–3.

    Article  PubMed  CAS  Google Scholar 

  63. Byrd RP, Roy TM. Rhabdomyolysis and bacterial pneumonia. Respir Med. 1998;92:359–62.

    Article  PubMed  Google Scholar 

  64. Knochel JP. Mechanisms of rhabdomyolysis. Curr Opin Rheumatol. 1993;5:725–31.

    Article  PubMed  CAS  Google Scholar 

  65. Zager RA. Rhabdomyolysis and myohemoglobinuric acute renal failure. Kidney Int. 1996;49:314–26.

    Article  PubMed  CAS  Google Scholar 

  66. Singh U, Scheld WM. Infectious etiologies of rhabdomyolysis: three case reports and review. Clin Infect Dis. 1996;22:642–9.

    Article  PubMed  CAS  Google Scholar 

  67. Will MJ, Hecker RB, Wathen PI. Primary varicella-zoster-induced rhabdomyolysis. South Med J. 1996;89:915–20.

    Article  PubMed  CAS  Google Scholar 

  68. Prendergast BD, George CF. Drug-induced rhabdomyolysis—mechanisms and management. Postgrad Med J. 1993;69:333–6.

    Article  PubMed  CAS  Google Scholar 

  69. Poels PJ, Gabreels FJ. Rhabdomyolysis: a review of the literature. Clin Neurol Neurosurg. 1993;95:175–92.

    Article  PubMed  CAS  Google Scholar 

  70. Morris AAM, Turnbull DM. Fatty acid oxidation defects in muscle. Curr Opin Neurol. 1998;11:485–90.

    Article  PubMed  CAS  Google Scholar 

  71. Slater MS, Mullins RJ. Rhabdomyolysis and myoglobinuric renal failure in trauma and surgical patients: a review. J Am Coll Surg. 1998;186:693–716.

    Article  PubMed  CAS  Google Scholar 

  72. Szewczyk D, Ovadia P, Abdullah F, Rabinovici R. Pressure-induced rhabdomyolysis and acute renal failure. J Trauma. 1998;44:384–8.

    Article  PubMed  CAS  Google Scholar 

  73. Pina EM, Mehlman CT. Rhabdomyolysis. A primer for the orthopaedist. Orthop Rev. 1994;23:28–32.

    PubMed  CAS  Google Scholar 

  74. Moghtader J, Brady WJ, Bonadio W. Exertional rhabdomyolysis in an adolescent athlete. Pediatr Emerg Care. 1997;13:382–5.

    Article  PubMed  CAS  Google Scholar 

  75. Strickland RA, Murray MJ. Fatal metabolic acidosis in a pediatric patient receiving an infusion of propofol in the intensive care unit: is there a relationship? Crit Care Med. 1995;23:405–9.

    Article  PubMed  CAS  Google Scholar 

  76. Segredo V, Caldwell JE, Matthay MA, et al. Persistent paralysis in critically ill patients after long-term administration of vecuronium. N Engl J Med. 1992;327:524–8.

    Article  PubMed  CAS  Google Scholar 

  77. Segredo V, Matthay MA, Sharma ML, et al. Prolonged neuromuscular blockade after long-term administration of vecuronium in two critically ill patients. Anesthesiology. 1990;72:566–70.

    Article  PubMed  CAS  Google Scholar 

  78. Kupfer Y, Namba T, Kaldawi E, Tessler S. Prolonged weakness after long-term administration of vecuronium bromide. Ann Intern Med. 1992;117:484–6.

    Article  PubMed  CAS  Google Scholar 

  79. Hunter JM. New neuromuscular blocking drugs. N Engl J Med. 1995;332:1691–9.

    Article  PubMed  CAS  Google Scholar 

  80. Feldman SA, Levi JA. Prolonged paresis following gallamine. Br J Anaesth. 1963;35:804–6.

    Article  PubMed  CAS  Google Scholar 

  81. Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011;10(10):931–41.

    Article  PubMed  Google Scholar 

  82. Hund E, Genzwurker E, Bohrer E, Jakob E, Thiele R, Hacke W. Predominant involvement of motor fibers in patients with critical illness polyneuropathy. Br J Anaesth. 1997;78:274–8.

    Article  PubMed  CAS  Google Scholar 

  83. Helliwell TR, Coakley JH, Wagenmakers AJM, et al. Necrotizing myopathy in critically- ill patients. J Pathol. 1991;164:307–14.

    Article  PubMed  CAS  Google Scholar 

  84. Wieske L, Harmsen RE, Schultz MJ, Horn J. Is critical illness neuromyopathy and duration of mechanical ventilation decreased by strict glucose control? Neurocrit Care. 2011;14:475–81.

    Article  PubMed  Google Scholar 

  85. Hund E, Herbert M, Becker CM, Hacke W. A humoral neurotoxic factor in sera of patients with critical illness polyneuropathy. Ann Neurol. 1996;40:539.

    Google Scholar 

  86. Friedrich O, Fink RA, Hund E. Understanding critical illness myopathy: approaching the pathomechanism. J Nutr. 2005;135:1813S–7.

    PubMed  CAS  Google Scholar 

  87. Chad DA, Lacomis D, Lacomis D. Critically ill patients with newly acquired weakness: the clinicopathological spectrum [ed]. Ann Neurol. 1994;35:257–9.

    Article  PubMed  CAS  Google Scholar 

  88. Gutmann L, Blumenthal D, Gutmann L, Schochet SS. Acute type II myofiber atrophy in critical illness. Neurology. 1996;46:819–21.

    Article  PubMed  CAS  Google Scholar 

  89. Larsson L, Li X, Edstrom L, et al. Acute quadriplegia and loss of muscle myosin in patients treated with nondepolarizing neuromuscular blocking agents and corticosteroids: mechanisms at the cellular and molecular levels. Crit Care Med. 2000;28:34–45.

    Article  PubMed  CAS  Google Scholar 

  90. Al-Lozi MT, Pestronk A, Yee WC, et al. Rapidly evolving myopathy with myosin- deficient fibers. Ann Neurol. 1994;35:273–9.

    Article  PubMed  CAS  Google Scholar 

  91. Mozaffar T, Haddal F, Zeng M, et al. Molecular and cellular defects of skeletal muscle in an animal model of acute quadriplegic myopathy. Muscle Nerve. 2006;35:55–65.

    Article  CAS  Google Scholar 

  92. Di Giovanni S, Mirabella M, D’Amico A, et al. Apoptotic features accompany acute quadriplegic myopathy. Neurology. 2000;55:854–8.

    Article  PubMed  Google Scholar 

  93. Di Giovanni S, Molon A, Broccolini A, et al. Constitutive activation of MAPK cascade in acute quadriplegic myopathy. Ann Neurol. 2004;55:195–206.

    Article  PubMed  CAS  Google Scholar 

  94. DuBois DC, Almon RR. A possible role for glucocorticoids in denervation atrophy. Muscle Nerve. 1991;14:1131–9.

    Article  Google Scholar 

  95. Dodson BA, Kelly BJ, Braswell LM, Cohen NH. Changes in acetylcholine receptor number in muscle from critically ill patients receiving muscle relaxants: an investigation of the molecular mechanism of prolonged paralysis. Crit Care Med. 1995;23:815–21.

    Article  PubMed  CAS  Google Scholar 

  96. Maggs AM, Huxley C, Hughes SM. Nerve-dependent changes in skeletal muscle myosin heavy chain after experimental denervation and cross-reinnervation and in a demyelinating mouse model of Charcot-Marie-Tooth disease type 1A. Muscle Nerve. 2008;38:1572–84.

    Article  PubMed  Google Scholar 

  97. Talmadge RJ. Myosin heavy chain isoform expression following reduced neuromuscular activity: potential regulatory mechanisms. Muscle Nerve. 2000;23:661–79.

    Article  PubMed  CAS  Google Scholar 

  98. Grana EA, Chiou-Tan F, Jaweed MM. Endplate dysfunction in healthy muscle following a period of disuse. Muscle Nerve. 1996;19:989–93.

    Article  PubMed  CAS  Google Scholar 

  99. Zochodne D. Myopathies in the intensive care unit. Can J Neurol Sci. 1998;25:540–2.

    Google Scholar 

  100. Rich MM, Teener JW, Raps EC, Schotland DL, Bird SJ. Muscle is electrically inexcitable in acute quadriplegic myopathy. Neurology. 1996;46:731–6.

    Article  PubMed  CAS  Google Scholar 

  101. Rich MM, Bird SJ, Raps EC, McCluskey LF, Teener JW. Direct muscle stimulation in acute quadriplegic myopathy. Muscle Nerve. 1997;20:665–73.

    Article  PubMed  CAS  Google Scholar 

  102. Rich MM, Pinter MJ, Kramer SD, Barchi RL. Loss of electrical excitability in an animal model of acute quadriplegic myopathy. Ann Neurol. 1998;43:171–9.

    Article  PubMed  CAS  Google Scholar 

  103. Allen DC, Arunachalam R, Mills KR. Critical illness myopathy: further evidence from muscle–fiber excitability studies of an acquired channelopathy. Muscle Nerve. 2008;37:14–22.

    Article  PubMed  Google Scholar 

  104. Anastasopoulos D, Kefaliakos A, Michalopoulos A. Is plasma calcium concentration implicated in the development of critical illness polyneuropathy and myopathy? Crit Care. 2011;15(5):R247.

    Article  PubMed  Google Scholar 

  105. Kraner SD, Wang Q, Novak KR, Cheng D, Cool DR, Peng J, et al. Upregulation of the Cav 1.1-ryanodine receptor complex in a rat model of critical illness myopathy. Am J Physiol Regul Inntegr Comp Physiol. 2011;300:R1384–91.

    Article  CAS  Google Scholar 

  106. Capasso M, Di Muzio A, Pandolfi A, et al. Possible role for nitric oxide dysregulation in critical illness myopathy. Muscle Nerve. 2008;37:196–202.

    Article  PubMed  CAS  Google Scholar 

  107. Lanone S, Mebazaa A, Heymes C, et al. Muscular contractile failure in septic patients. Role of the inducible nitric oxide synthase pathway. Am J Respir Crit Care Med. 2000;162:2308–15.

    Article  PubMed  CAS  Google Scholar 

  108. Massa R, Carpenter S, Holland P, Karpati G. Loss and renewal of thick myofilaments in glucocorticoid-treated rat soleus after denervation and reinnervation. Muscle Nerve. 1992;15:1290–8.

    Article  PubMed  CAS  Google Scholar 

  109. Rouleau G, Karpati G, Carpenter S, et al. Glucocorticoid excess induces preferential depletion of myosin in denervated skeletal muscle fibers. Muscle Nerve. 1987;10:428–38.

    Article  PubMed  CAS  Google Scholar 

  110. Sassoon CS, Zhu E, Pham HT, et al. Acute effects of high-dose methylprednisolone on diaphragm muscle function. Muscle Nerve. 2008;38:1161–72.

    Article  PubMed  CAS  Google Scholar 

  111. Rundback JH, Shah PM, Wong J, et al. Livedo reticularis, rhabdomyolysis, massive intestinal infarction, and death after carbon dioxide arteriography. J Vasc Surg. 1997;26:337–40.

    Article  PubMed  CAS  Google Scholar 

  112. Ruff RL. Why do patients with McArdle’s disease have decreased exercise capacity? [Editorial]. Neurology. 1998;50:6–7.

    Article  PubMed  CAS  Google Scholar 

  113. Haller RG, Clausen T, Vissing J. Reduced levels of skeletal muscle Na+K+-ATPase in McArdle’s disease. Neurology. 1998;50:37–40.

    Article  PubMed  CAS  Google Scholar 

  114. Morrison WL, Gibson JN, Rennie MJ. Skeletal muscle and whole body protein turnover in cardiac cachexia: influence of ­branched-chain amino acid administration. Eur J Clin Invest. 1988;18:648–54.

    Article  PubMed  CAS  Google Scholar 

  115. Fong Y, Moldawer LL, Marano M, et al. Cachectin/TNF or IL-1 alpha induces cachexia with redistribution of body proteins. Am J Physiol. 1989;256(3 Pt 2):R659–65.

    PubMed  CAS  Google Scholar 

  116. Legerlotz K, Smith HK. Role of MyoD in denervated, disused, and exercised muscle. Muscle Nerve. 2008;38:1087–100.

    Article  PubMed  CAS  Google Scholar 

  117. Wokke JH, Jennekens FG, vanden Oord CJ, Veldman H, van Gijn J. Histological investigations of muscle atrophy and end plates in two critically ill patients with generalized weakness. J Neurol Sci. 1988;88:95–106.

    Article  PubMed  CAS  Google Scholar 

  118. Wernig A, Pécot-Dechavassine M, Stöver H. Sprouting and ­regression of the nerve at the frog neuromuscular junction in ­normal conditions and after prolonged paralysis with curare. J Neurocytol. 1980;9:277–303.

    Article  Google Scholar 

  119. Berg DK, Hall ZW. Increased extrajunctional acetylcholine ­sensitivity produced by chronic post-synaptic neuromuscular blockade. J Physiol. 1975;244:659–76.

    PubMed  CAS  Google Scholar 

  120. Chen R. Electrophysiological studies in the critical care unit: investigating polyneuropathies. Can J Neurol Sci. 1998;25:S32–5.

    PubMed  CAS  Google Scholar 

  121. Wijdicks EFM, Litchy WJ, Harrison BA, Gracey DR. The clinical spectrum of critical illness polyneuropathy. Mayo Clin Proc. 1994;69:955–9.

    Article  PubMed  CAS  Google Scholar 

  122. Op de Coul AAW, Verheul GAM, Leyten ACM, et al. Critical illness polyneuropathy after artificial respiration. Clin Neurol Neurosurg. 1991;93:27–33.

    Article  Google Scholar 

  123. Sun DY, Edgar M, Rubin M. Hemiparetic acute myopathy of intensive care progressing to triplegia. Arch Neurol. 1997;54:1420–2.

    Article  PubMed  CAS  Google Scholar 

  124. Gorson KC, Ropper AH. Generalized paralysis in the intensive care unit: emphasis on the complications of neuromuscular blocking agents and corticosteroids. J Intensive Care Med. 1996;11:219–31.

    Google Scholar 

  125. Spitzer AR, Giancarlo T, Maher L, Awerbuch G, Bowles A. Neuromuscular causes of prolonged ventilator dependency. Muscle Nerve. 1992;15:682–6.

    Article  PubMed  CAS  Google Scholar 

  126. Bolton CF. Electrophysiological studies of critically ill patients. Muscle Nerve. 1987;10:129–35.

    Article  PubMed  CAS  Google Scholar 

  127. Bolton CF. AAEM minimonograph #40: clinical neurophysiology of the respiratory system. Muscle Nerve. 1993;16:809–18.

    Article  PubMed  CAS  Google Scholar 

  128. Campbell JW, Herbison GJ, Chen YT, Jaweed MM, Gussner CG. Spontaneous electromyographic potentials in chronic spinal cord injured patients: relation to spasticity and length of nerve. Arch Phys Med Rehabil. 1991;72:23–7.

    PubMed  CAS  Google Scholar 

  129. Rivner MH, Kim S, Greenberg M, Swift TR. Reversible generalized paresis following hypotension: a new neurological entity. Neurology. 1983;33 Suppl 2Suppl 2:164–5 [abstract].

    Google Scholar 

  130. Rana SS, Giuliani MJ, Oddis CV, Lacomis D. Acute onset of colchicine myoneuropathy in cardiac transplant recipients: case studies of three patients. Clin Neurol Neurosurg. 1997;99:266–70.

    Article  PubMed  CAS  Google Scholar 

  131. Abdel-Hamid H, Oddis CV, Lacomis D. Severe hydroxychloroquine myopathy. Muscle Nerve. 2008;38:1206–10.

    Article  PubMed  Google Scholar 

  132. Bertorini TE. Myoglobinuria, malignant hyperthermia, neuroleptic malignant syndrome and serotonin syndrome. Neurol Clin. 1997;15:649–71.

    Article  PubMed  CAS  Google Scholar 

  133. de Galan BE, Joekstra JBL. Extremely elevated body temperature: case report and review of classical heat stroke. Neth J Med. 1995;47:281–7.

    Article  PubMed  Google Scholar 

  134. Dar KJ, McBrien ME. MDMA induced hyperthermia: report of a fatality and review of current therapy. Intensive Care Med. 1996;22:995–6.

    Article  PubMed  CAS  Google Scholar 

  135. Zifko UA, Zipko HT, Bolton CF. Clinical and electrophysiological findings in critical illness polyneuropathy. J Neurol Sci. 1998;159:186–93.

    Article  PubMed  CAS  Google Scholar 

  136. Schwarz J, Planck J, Briegel J, Straube A. Single-fiber ­electromyography, nerve conduction studies, and conventional ­electromyography in patients with critical illness polyneuropathy: evidence for a lesion of terminal motor axons. Muscle Nerve. 1997;20:696–701.

    Article  PubMed  CAS  Google Scholar 

  137. Trojaborg W, Weimer LH, Hays AP. Electrophysiologic studies in critical illness associated weakness: myopathy or neuropathy – a reappraisal. Clin Neurophysiol. 2001;12:1586–93.

    Article  Google Scholar 

  138. Fernández-Lorente J, Esteban A, Salinero E, Traba A, Prieto J, Palencia E. Critical illness myopathy. Neurophysiological and muscular biopsy assessment in 33 patients. Rev Neurol. 2010;50(12):718–26.

    PubMed  Google Scholar 

  139. Raghig H, Young GB, Hammond R, Nicolle M. A comparison of EMG and muscle biopsy in ICU weakness. Neurocrit Care. 2010;13(3):326–30.

    Article  PubMed  Google Scholar 

  140. Matsuda N, Kobayashi S, Tanji Y, Hasegawa A, Tase C, Ugawa Y. Widespread muscle involvement in critical illness myopathy revealed by MRI. Muscle Nerve. 2011;44:842–4.

    Article  PubMed  Google Scholar 

  141. Park EJ, Nishida T, Sufit RL, et al. Prolonged compound muscle action potential duration in critical illness myopathy. Report of nine cases. J Clin Neuromuscul Dis. 2004;5:176–83.

    PubMed  Google Scholar 

  142. Trojaborg W. Electrophysiologic techniques in critical illness-­associated weakness. J Neurol Sci. 2006;242:83–5.

    Article  PubMed  Google Scholar 

  143. Goodman BP, Harper CM, Boon AJ. Prolonged compound muscle action potential duration in critical illness myopathy. Muscle Nerve. 2009;40:1040–2.

    Article  PubMed  Google Scholar 

  144. Z’Graggen WJ, Brander L, Tuchscherer D, Scheidegger O, Takala J, Bostock H. Muscle membrane dysfunction in critical ­illness myopathy assessed by velocity recovery cycles. Clin Neurophysiol. 2011;122:834–41145.

    Article  PubMed  CAS  Google Scholar 

  145. Lacomis D, Zochodne D, Bird S. Critical illness myopathy. Muscle Nerve. 2000;23:1785–8 (editorial).

    Article  PubMed  CAS  Google Scholar 

  146. Bolton CF. Neuromuscular manifestations of critical illness. Muscle Nerve. 2005;32:140–63.

    Article  PubMed  Google Scholar 

  147. Stevens RD, Marshall SA, Cornblath DR, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med. 2009;37(Suppl):S299–308.

    Article  PubMed  Google Scholar 

  148. Al-Shekhlee A, Hachwi R, Jaberi MM, et al. The electromyographic features of acute rhabdomyolysis. J Clin Neuromuscul Dis. 2005;6:114–8.

    Article  PubMed  Google Scholar 

  149. Intiso D, Amoruso L, Zarrelli M, et al. Long-term functional outcome and health status of patients with critical illness polyneuromyopathy. Acta Neurol Scand. 2011;123:211–9.

    Article  PubMed  CAS  Google Scholar 

  150. Novak P, Vidmar G, Kuret Z, Bizovičar N. Rehabilitation of critical illness polyneuropathy and myopathy patients: an observational study. Int J Rehabil Res. 2011;34:336–42.

    Article  PubMed  Google Scholar 

  151. Wijdicks EFM, Fulgham JR. Failure of high dose intravenous immunoglobulins to alter the clinical course of critical illness polyneuropathy. Muscle Nerve. 1994;17:1494–5 (letter).

    PubMed  CAS  Google Scholar 

  152. Mohr M, Englisch L, Roth A, Burchardi H, Zielmann S. Effects of early treatment with immunoglobulin on critical illness polyneuropathy following multiple organ failure and gram negative sepsis. Intensive Care Med. 1997;23:1144–9.

    Article  PubMed  CAS  Google Scholar 

  153. Leijten FS, Harnick-de Weard JE, Poortuliet DC, de Weerd AW. The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation. JAMA. 1995;274:1221–5.

    Article  PubMed  CAS  Google Scholar 

  154. Latronico N, Bertolini G, Guarneri B, et al. Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multicenter CRIMYNE study. Crit Care. 2007;11:R11.

    Article  PubMed  Google Scholar 

  155. Koch S, Spuler S, Deja M, Bierbrauer J, Dimroth A, Behse F, et al. Critical illness myopathy is frequent: accompanying neuropathy protracts ICU discharge. J Neurol Neurosurg Psychiatry. 2011;82:287–93.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Neurology and Pathology (Neuropathology), University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    David Lacomis MD

  2. Department of Neurology, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH F-878, Pittsburgh, PA, 15213, USA

    Ahmed El-Dokla MD

Authors
  1. David Lacomis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmed El-Dokla MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Lacomis MD .

Editor information

Editors and Affiliations

  1. School of Medicine Department of Neurology, University Hospitals Case Medical Center Case Western Reserve University, Cleveland, Ohio, USA

    Bashar Katirji

  2. Department of Neurology, George Washington University, Washington, District of Columbia, USA

    Henry J. Kaminski

  3. University School of Medicine Department of Neurology, Louis Stokes Cleveland VA Medical Center Case Western Reserve, Cleveland, Ohio, USA

    Robert L. Ruff

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Lacomis, D., El-Dokla, A. (2014). Acute Neuromuscular Weakness in the Intensive Care Unit. In: Katirji, B., Kaminski, H., Ruff, R. (eds) Neuromuscular Disorders in Clinical Practice. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6567-6_76

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6567-6_76

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6566-9

  • Online ISBN: 978-1-4614-6567-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation