Neuromuscular Abnormalities in Critical Illness

  • T. Sharshar
  • M. D. Outin
  • B. de Jonghe
Conference paper

Abstract

It is now well established that critical illness can be complicated by neuromuscular disorders, conventionally termed critical-illness neuromuscular abnormalities (CINMA) that can affect nerve, neuromuscular junction or muscle. Failure to wean from ventilatory support is a major cause of prolonged intensive care unit (ICU) stay with associated morbidity, mortality and cost. CINMA may play a significant role in this. In addition, it can have an impact on long-term functional outcome. Despite numerous studies on the incidence and risk factors for CINMA as well as its clinical, electrophysiological and histopathological features, several key areas remain unclear. Specifically, the pathophysiological substrate of CINMA, the electrophysiological and histological changes, and the relationship between these abnormalities and actual functional impairment have not been fully elucidated. In addition, advances in understanding of this condition have had only limited impact in terms of developing effective preventative and therapeutic interventions. An exception to this is the recently established benefit of maintaining normoglycemia in critically ill patients. Systematic recognition of this condition requires intensivists to be aware of its clinical findings, the indications for neurophysiological testing and biopsy, and the tools for the assessment of respiratory muscle strength. Management requires a multidisciplinary approach and does not stop at the ICU door.

Keywords

Ischemia Corticosteroid Respiration Neuropathy Immobilization 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • T. Sharshar
  • M. D. Outin
  • B. de Jonghe

There are no affiliations available

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