Intensive Care Medicine

, Volume 31, Issue 1, pp 157–161 | Cite as

Steroid-induced myopathy in patients intubated due to exacerbation of chronic obstructive pulmonary disease

  • Rosario Amaya-Villar
  • Jose Garnacho-Montero
  • Jose Luis García-Garmendía
  • Juan Madrazo-Osuna
  • M. Carmen Garnacho-Montero
  • Rafael Luque
  • Carlos Ortiz-Leyba
Brief Report

Abstract

Objective

To determine incidence, risk factors and impact on various outcome parameters of the development of acute quadriplegic myopathy in a selected population of critically ill patients.

Setting

A prospective cohort study carried out in the intensive care unit of a tertiary-level university hospital.

Patients

All patients admitted due to acute exacerbation of chronic obstructive pulmonary disease who required intubation and mechanical ventilation, and received high doses of intravenous corticosteroids.

Interventions

A neurophysiological study was performed in all cases at the onset of weaning. Muscular biopsy was taken when the neurophysiological study revealed a myopathic pattern.

Measurements and results

Twenty-six patients were enrolled in the study. Nine patients (34.6%) developed myopathy. Only seven patients were treated with muscle relaxants. Histology confirmed the diagnosis in the three patients who underwent muscle biopsy. APACHE II score at admission, the rate of sepsis and the total doses of corticosteroids were significantly higher in patients with myopathy compared with those patients that did not develop it. Myopathy is associated with an increase in the duration of mechanical ventilation [15.4 (9.2) versus 5.7 (3.9) days; p<0.006], the length of ICU stay [23.6 (10.7) versus 11.4 (7.05) days; p<0.003] and hospital stay [33.3 (19.2) versus 21.2 (16.1) days; p<0.034)]. Myopathy was not associated with increased mortality.

Conclusions

In the population under study, severity of illness at admission, the development of sepsis and the total dose of corticosteroids are factors associated with the occurrence of myopathy after the administration of corticosteroids. Myopathy was associated with prolonged mechanical ventilation and in-hospital stay.

Keywords

Myopathy Sepsis Chronic obstructive pulmonary disease Corticosteroids Mechanical ventilation 

References

  1. 1.
    Bolton CF (1987) Electrophysiologic studies of critically ill patients. Muscle Nerve 10:129–135PubMedGoogle Scholar
  2. 2.
    Garnacho-Montero J, Madrazo-Osuna J, García-Garmendia JL, Ortiz-Leyba C (2001) Neuromuscular disorders of the critically ill patient. Clin Pulmon Med 8:354–359CrossRefGoogle Scholar
  3. 3.
    Leatherman JW, Fluegel WL, David WS, Davies SF, Iber C (1996) Muscle weakness in mechanically ventilated patients with severe asthma. Am J Respir Crit Care Med 153:1686–1690PubMedGoogle Scholar
  4. 4.
    Behbehani NA, Al-Mane F, D’yachkova Y, Paré P, FitzGerald JM (1999) Myopathy following mechanical ventilation for acute severe asthma. The role of muscle relaxants and corticosteroids. Chest 115:1627–1631CrossRefPubMedGoogle Scholar
  5. 5.
    Hanson P, Dive A, Brucher JM, Bisteau M, Dangoisse M, Deltombe T (1997) Acute corticosteroids myopathy in intensive care medicine. Muscle Nerve 20:1371–1380PubMedGoogle Scholar
  6. 6.
    Deconinck N, Van Parijs V, Beckers-Bleuks G, Van den Bergh (1998) Critical illness myopathy unrelated to corticosteroids or neuromuscular blocking agents. Neuromusc Disord 8:186–192CrossRefPubMedGoogle Scholar
  7. 7.
    American Thoracic Society standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (1995) Am J Respir Crit Care Med 152: S78–S121Google Scholar
  8. 8.
    Garnacho-Montero J, Madrazo-Osuna J, García-Garmendia JL, Ortiz Leyba C, Jiménez-Jiménez FJ, Barrero-Almodóvar AE, Garnacho-Montero MC, Moyano-del-Estad MR (2001) Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med 27:1288–1296CrossRefPubMedGoogle Scholar
  9. 9.
    American College of Chest Physicians/Society of Critical Care Medicine Consensus Committee (1992) Definition for sepsis and organ dysfunction/failure. Chest 101:1658–1662Google Scholar
  10. 10.
    Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdu I, Fernández R, de la Cal MA, Benito S, Tomas R (1995) A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med 332:345–350CrossRefPubMedGoogle Scholar
  11. 11.
    Kimura J, Dickins QS (1991) Electrodiagnosis of neuromuscular disorders. In: Neurology in clinical practice. principal of diagnosis and management. Bradley WG, Daroff RB, Fenichel GM, DC Marsden (eds), Britterworth-Heinemann, Boston, pp 452–467Google Scholar
  12. 12.
    Lacomis D, Giuliani M, Van Cott A, Kramer DJ (1996) Acute myopathy of intensive care: clinical, electromyographic and pathological aspects. Ann Neurology 40:645–654Google Scholar
  13. 13.
    Adnet F, Dhissi G, Borron SW, Galinski M, Rayeh F, Cupa M, Pourriat JL, Lapostolle F (2001) Complication profiles of adult asthmatics requiring paralysis during mechanical ventilation. Intensive Care Med 27:1729–1736CrossRefPubMedGoogle Scholar
  14. 14.
    De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zales I, Boussarsar M, Cerf C, Renaud E, Mesrati F, Carlet J, Raphael JC, Outin H, Bastuji-Garin S (2002) Paresis acquired in the intensive care unit. A prospective multicenter study. JAMA 288:2859–2867PubMedGoogle Scholar
  15. 15.
    Wilcox P, Milliken C, Bresller B (1996) High-dose tumor necrosis factor alpha produces an impairment of hamster diaphragm contractility. Attenuation with a prostaglandin inhibitor. Am J Resp Crit Care Med 153:1611–1615PubMedGoogle Scholar
  16. 16.
    Reid MB, Lannergren J, Westerblad H (2002) Respiratory and limb muscle weakness induced by tumor necrosis factor-α. Involvement of muscle myofilaments. Am J Respir Crit Care Med 166:479–484CrossRefPubMedGoogle Scholar
  17. 17.
    Latronico N, Fenzi F, Recupero D, Guaneri B, Tomelleri G, Tonin P, De Maria G, Antonini L, Rizzuto N, Candiani A (1996) Critical illness myopathy and neuropathy. Lancet 347:1579–1582CrossRefPubMedGoogle Scholar
  18. 18.
    Tiao G, Hobler S, Wang JJ, Meyer TA, Luchette FA, Fischer JE, Hasselgren PO (1997) Sepsis is associated with increased mRNAs of ubiquitin-proteasome proteolytic pathway in human skeletal muscle. J Clin Invest 99:163–168PubMedGoogle Scholar
  19. 19.
    De Jonghe B, Bastuji-Garin S, Sharshar T, Outin H, Brochard L (2004) Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med 30:1117–1121CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Rosario Amaya-Villar
    • 1
  • Jose Garnacho-Montero
    • 1
  • Jose Luis García-Garmendía
    • 1
  • Juan Madrazo-Osuna
    • 2
  • M. Carmen Garnacho-Montero
    • 1
  • Rafael Luque
    • 3
  • Carlos Ortiz-Leyba
    • 1
  1. 1.Intensive Care UnitUniversity Hospital Virgen del RocíoSevillaSpain
  2. 2.Department of Clinical NeurophysiologyUniversity Hospital Virgen del RocíoSevillaSpain
  3. 3.Department of PathologyUniversity Hospital Virgen del RocíoSevillaSpain

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