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Critical illness neuromuscular disease: clinical, electrophysiological, and prognostic aspects
B Tabarki1, A Coffiniéres, P Van Den Bergh
1Service de neuropédiatrie et service de neurologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium. bmlaiki@excite.fr
Insights
Critical illness neuromuscular disease is poorly understood in children. This study found critical illness neuropathy and myopathy cause paralysis in critically ill children, suggesting restricted corticosteroid and muscle relaxant use.
Area of Science:
- Pediatric critical care medicine
- Neuromuscular disorders
- Intensive care unit (ICU) acquired weakness
Background:
- Critical illness neuromuscular disease (CINMD) is a recognized entity in adults.
- CINMD in pediatric populations is not well-characterized.
- Understanding pediatric CINMD is crucial for appropriate patient management.
Observation:
- A retrospective study was conducted at a children's university hospital.
- Five critically ill pediatric patients with generalized paralysis were identified.
- Patients experienced prolonged respiratory failure.
Findings:
- The causes of paralysis included critical illness neuropathy (two patients), acute myopathy (two patients), and mixed neuromyopathy (one patient).
- The study identified specific neuromuscular pathologies in critically ill children.
- Electrophysiological and prognostic features were assessed.
Implications:
- Neuromuscular disease should be suspected in critically ill children presenting with muscle weakness.
- Corticosteroids and muscle relaxants may precipitate CINMD in children.
- Restricting or minimizing the use of these agents is recommended to prevent or mitigate pediatric CINMD.
Background:
Critical illness neuromuscular disease, which has been recognised as a distinct clinical entity in adults, remains poorly described in children.
Aims:
To assess retrospectively the clinical, electrophysiological, and prognostic features of the disease.
Methods:
Retrospective study in a children's university hospital.
Results:
Five critically ill patients presented with generalised paralysis, associated with long lasting failure to breathe in three. The cause of the generalised paralysis was critical illness neuropathy in two, acute myopathy in two, and mixed neuromyopathy in one.
Conclusions:
Neuromuscular disease should be suspected in critically ill children with muscle weakness. Because corticosteroids and muscle relaxants appear to trigger some types of intensive care unit neuromuscular disease in children, their use should be restricted or administered at the lowest doses possible.