Advertisement

Intensive Care Medicine

, Volume 29, Issue 9, pp 1411–1413 | Cite as

Neuromuscular alterations in the critically ill patient: critical illness myopathy, critical illness neuropathy, or both?

  • Nicola LatronicoEmail author
Editorial

"During a four year period, five patients developed a severe polyneuropathy within one month of admission to a critical care unit" [1]. When first systematically described in the early 1980s, critical illness polyneuropathy (CIP) seemed no more than a scientific curiosity. Research over the past 20 years from Europe and Canada, however, has shown that CIP is the most frequent acute polyneuropathy encountered in the critically ill patients [2]. Although the exact incidence in unknown due to wide variation in diagnostic criteria and patients case-mix, available data regarding the incidence of CIP in critically ill patients are rather impressive: 58% in patients with a prolonged (>1 week) intensive care unit (ICU) stay [3], 68.5% in patients with sepsis [4], 70% in patients with multiple organ failure [5], 76% in patients with septic shock [6], and 82% in patients with sepsis and multiple organ failure [7]. If a prudent estimate is accepted that two patients with CIP are discharged...

References

  1. 1.
    Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ (1984) Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry 47:1223–1231PubMedGoogle Scholar
  2. 2.
    Leijten FSS, Harinck-de Werd JE, Poortvliet DCJ, de Weerd AW (1995) The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation. JAMA 274:1221–1225PubMedGoogle Scholar
  3. 3.
    De Jonghe B, Cook D, Sharshar, Lefaucheur JP, Carlet J, Outin H, Groupe de Reflexion et d'Etude sur les Neuromyopathies En Reanimation (1998) Acquired neuromuscular disorders in critically ill patients: a systematic review. Intensive Care Med 24:1242–1250Google Scholar
  4. 4.
    Garnacho-Montero J, Madrazo-Osuna J, Garcìa-Garmendia JL, Ortiz-Leyba C, Jiménez-Jiménez FJ, Barrero-Almodovar A, Garnacho-Montero MC, Moyan-Del-Estad MR (2001) Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med 27:1288–1296Google Scholar
  5. 5.
    Witt NJ, Zochodne DW, Bolton CF, Grand'Maison F, Wells G, Young B, Sibbald WJ (1991) Peripheral nerve function in sepsis and multiple organ failure. Chest 99:176–184PubMedGoogle Scholar
  6. 6.
    Tepper M, Rakic S, Haas JA, Woittiez AJJ (2000) Incidence and onset of critical illness polyneuropathy in patients with septic shock. Neth J Med 56:211–214Google Scholar
  7. 7.
    Berek K, Margreiter J, Willeit J, Berek A, Smutzhard E, Mutz NJ (1996) Polyneuropathies in critically ill patients: a prospective evaluation. Intensive Care Med 22:849–854PubMedGoogle Scholar
  8. 8.
    Séze M de, Petit H, Wiart L, Cardinaud JP, Gaujard E, Joseph PA, Mazaux JM, Barat M (2000) Critical illness polyneuropathy. A 2-year follow-up in 19 severe cases. Eur Neurol 43:61–69CrossRefPubMedGoogle Scholar
  9. 9.
    Fletcher SN, Kennedy DD, Ghosh IR, Misra VP, Kiff K, Coakley JH, Hinds CJ (2003) Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med 31:1012–1016PubMedGoogle Scholar
  10. 10.
    Zochodne DW, Charles F. Bolton CF (1996) Neuromuscular disorders in critical illness. In: Bolton CF, Young GB (eds) Bailliere's clinical neurology. Bailliere Tindall, pp 645–671Google Scholar
  11. 11.
    Morris C, Trinder JT (2002) Electrophysiology adds little to clinical signs in critical illness polyneuropathy and myopathy. Crit Care Med 30:2612Google Scholar
  12. 12.
    Latronico N, Fenzi F, Recupero D, Guarneri B, Tomelleri G, Tonin P, De Maria G, Antonini L, Rizzuto N, Candiani A (1996) Critical illness myopathy and neuropathy. Lancet 347:1579–1582PubMedGoogle Scholar
  13. 13.
    Coakley JH, Nagendran K, Yarwood GD, Honavar M, Hinds CJ (1998) Patterns of neurophysiological abnormality in prolonged critical illness. Intensive Care Med 24:801–807Google Scholar
  14. 14.
    Rich MM, Bird SJ, Raps EC, McCluskey LF, Teener JW (1997) Direct muscle stimulation in acute quadriplegic myopathy. Muscle Nerve 20:665–673CrossRefPubMedGoogle Scholar
  15. 15.
    De Letter MACJ, van Doorn PA, Savelkoul HFJ, Laman JD, Schmitz PIM, Op de Coul AAW, Visser LH, KrosJM, Teepen ILIM, van der Meche FGA (2000) Critical illness polyneuropathy and myopathy (CIPNM): evidence for local immune activation by cytokine-expression in the muscle tissue. J Neuroimmunol 106:206–213CrossRefPubMedGoogle Scholar
  16. 16.
    Trojaborg W, Weimer LH, Hays AP (2001) Electrophysiologic studies in critical illness associated weakness: myopathy or neuropathy—a reappraisal. Clin Neurophysiol 112:1586–1593Google Scholar
  17. 17.
    De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, Cerf C, Renaud E, Mesrati F, Carlet J, Raphael JC, Outin H, Bastuji-Garin S, for the Groupe de Reflexion et d'Etude des Neuromyopathies en Réanimation (2002) Paresis acquired in the intensive care unit. A prospective multicenter study. JAMA 288:2859–2867PubMedGoogle Scholar
  18. 18.
    Latronico N, Candiani A (1998) Muscular wasting as a consequence of sepsis. In: Gullo A (ed) Anaesthesia, pain, intensive care and emergency medicine, A.P.I.C.E., vol 13. Springer Italia, Milan, pp 517–522Google Scholar
  19. 19.
    Troni W, Cantello R, Rainero I (1983) Conduction velocity along human muscle fibers in situ. Neurology 33:1453–1459PubMedGoogle Scholar
  20. 20.
    Bednarik J, Lukas Z, Vondracek P (2003) Critical illness polyneuromyopathy: the electrophysiological components of a complex entity. Intensive Care Med (http://dx.doi.org/10.1007/s00134-003-1858-0)Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Institute of Anesthesiology-Intensive CareUniversity of BresciaBresciaItaly

Personalised recommendations