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Journal of Neurology

, Volume 260, Issue 1, pp 151–157 | Cite as

Long-term neuromuscular sequelae of critical illness

  • Alexander SemmlerEmail author
  • Torsten Okulla
  • Markus Kaiser
  • Burkhardt Seifert
  • Michael T. Heneka
Original Communication

Abstract

In this observational study, we analyzed the long-term neuromuscular deficits of survivors of critical illness. Intensive care unit-acquired muscular weakness (ICU-AW) is a very common complication of critical illness. Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) are two main contributors to ICU-AW. ICU-AW is associated with an increased mortality and leads to rehabilitation problems. However, the long-term outcome of ICU-AW and factors influencing it are not well known. We analyzed the medical records of 490 survivors of critical illness, aged 18–75 years and located in the area of the study center. Intensive care unit (ICU) survivors with comorbidities that might influence neuromuscular follow-up examinations, muscle strength, or results of nerve conduction studies, such as renal or hepatic insufficiency, diabetes mellitus, or vitamin deficiency were excluded. A total of 51 patients were finally included in the study. Six to 24 months after discharge from the ICU, we measured the Medical Research Council (MRC) sum score, the Overall Disability Sum score (ODSS), and also performed nerve conduction studies and EMG. For all ICU survivors, the median MRC sum score was 60 (range 47–60) and the median ODSS score was 0 (range 0–8). CIP was diagnosed in 21 patients (41 %). No patient was diagnosed with CIM. Patients with diagnosis of CIP showed a higher median ODSS scores 1 (range 0–8) versus 0 (range 0–5); p < 0.001 and lower median MRC sum scores 56 (range 47–60) versus 60 (range 58–60); p < 0.001. The three main outcome variables MRC sum score, ODSS score and diagnosis of CIP were not related to age, gender, or diagnosis of sepsis. The MRC sum score (r = −0.33; p = 0.02) and the ODSS score (r = 0.31; p = 0.029) were correlated with the APACHE score. There was a trend for an increased APACHE score in patients with diagnosis of CIP 19 (range 6–33) versus 16.5 (range 6–28); p = 0.065. Patients with the diagnosis of CIP had more days of ICU treatment 11 days (range 2–74) versus 4 days (range 1–61); p = 0.015, and had more days of ventilator support 8 days (range 1–59) versus 2 days (range 1–46); p = 0.006. The MRC sum score and the ODSS score were correlated with the days of ICU treatment and with the days of ventilator support. The neuromuscular long-term consequences of critical illness were not severe in our study population. As patients with concomitant diseases and old patients were excluded from this study the result of an overall favorable prognosis of ICU-acquired weakness may not be true for other patient’s case-mix. Risk factors for the development of long-term critical illness neuropathy are duration of ICU treatment, duration of ventilator support, and a high APACHE score, but not diagnosis of sepsis. Although ICU-AW can be serious complication of ICU treatment, this should not influence therapeutic decisions, given its favorable long-term prognosis, at least in relatively young patients with no concomitant diseases.

Keywords

Critical illness Long-term neuromuscular outcome Nerve conduction Critical illness polyneuropathy Critical illness myopathy 

Notes

Acknowledgments

We acknowledge the excellent technical assistance of Mrs. Kömpel-Retzmann in performing the nerve conduction studies.

Conflicts of interest

The authors declare that they have no competing interests.

Ethical standards

The authors hereby declare that the research documented in the submitted manuscript have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Alexander Semmler
    • 1
    Email author
  • Torsten Okulla
    • 2
  • Markus Kaiser
    • 3
  • Burkhardt Seifert
    • 4
  • Michael T. Heneka
    • 2
  1. 1.Department of NeurologyUniversity of ZurichZurichSwitzerland
  2. 2.Department of NeurologyUniversity of BonnBonnGermany
  3. 3.Department of Anaesthesiology and Intensive Care MedicineUniversity of BonnBonnGermany
  4. 4.Division of Biostatistics, Institute of Social and Preventive MedicineUniversity of ZurichZurichSwitzerland

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