Intensive Care Medicine

, Volume 33, Issue 11, pp 1876–1891 | Cite as

Neuromuscular dysfunction acquired in critical illness: a systematic review

  • Robert D. Stevens
  • David W. Dowdy
  • Robert K. Michaels
  • Pedro A. Mendez-Tellez
  • Peter J. Pronovost
  • Dale M. Needham
SYSTEMATIC REVIEW

Abstract

Objective

To determine the prevalence, risk factors, and outcomes of critical illness neuromuscular abnormalities (CINMA).

Design

Systematic review.

Data sources and study selection

MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched for reports on adult ICU patients who were evaluated for CINMA clinically and electrophysiologically. Studies were included if they contained sufficient data to quantify the association between CINMA and relevant exposures and/or outcome variables.

Measurements and results

CINMA was diagnosed in 655 of 1421 [46% (95% confidence interval 43–49%)] adult ICU patients enrolled in 24 studies, all with inclusion criteria of sepsis, multi-organ failure, or prolonged mechanical ventilation. Diagnostic criteria for CINMA were not uniform, and few reports unequivocally differentiated between polyneuropathy, myopathy, and mixed types of CINMA. The risk of CINMA was associated with hyperglycemia (and inversely associated with tight glycemic control), the systemic inflammatory response syndrome, sepsis, multiple organ dysfunction, renal replacement therapy, and catecholamine administration. Across studies, there was no consistent relationship between CINMA and patient age, gender, severity of illness, or use of glucocorticoids, neuromuscular blockers, aminoglycosides, or midazolam. Unadjusted mortality was not increased in the majority of patients with CINMA, but mechanical ventilation and ICU and hospital stay were prolonged.

Conclusions

The risk of CINMA is nearly 50% in ICU patients with sepsis, multi-organ failure, or protracted mechanical ventilation. The association of CINMA with frequently cited CINMA risk factors (glucocorticoids, neuromuscular blockers) and with short-term survival is uncertain. Available data indicate glycemic control as a potential strategy to decrease CINMA risk.

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Robert D. Stevens
    • 1
    • 2
    • 3
  • David W. Dowdy
    • 4
  • Robert K. Michaels
    • 1
  • Pedro A. Mendez-Tellez
    • 1
  • Peter J. Pronovost
    • 1
    • 5
    • 6
  • Dale M. Needham
    • 7
  1. 1.Department of Anesthesiology/Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of NeurologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of NeurosurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  7. 7.Department of Pulmonary/Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreUSA

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