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[Critical illness neuropathies].

M R Magistris1

  • 1Unité d'Electroneuromyographie et des Affections Neuromusculaires, Clinique de Neurologie, Hôpital Universitaire de Genève, Suisse. michel.magistris@hcuge.ch

Revue Neurologique
|April 27, 2002
PubMed
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Patients in intensive care units can develop neuromuscular complications like critical illness polyneuropathy or weakness from neuromuscular blockers. Early identification and management are key for better patient outcomes and recovery.

Area of Science:

  • Neurology
  • Intensive Care Medicine
  • Critical Care

Context:

  • Patients in intensive care units (ICUs) for non-neurological conditions can develop acute neuromuscular complications.
  • These complications manifest as generalized weakness, potentially with sensory symptoms.
  • Two primary conditions are critical illness polyneuropathy and neuromuscular disorders linked to neuromuscular blocking agents.

Purpose:

  • To differentiate between critical illness polyneuropathy and neuromuscular disorders related to neuromuscular blocking agents.
  • To outline the distinct clinical presentations, risk factors, and prognoses of these conditions.
  • To highlight the impact of these disorders on patient recovery and ICU stay duration.

Summary:

  • Critical illness polyneuropathy: associated with prolonged ICU stays, multiple organ dysfunction, sepsis; axonal, affecting sensory and motor fibers; high mortality (60%); slow recovery (months).

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  • Neuromuscular disorder from blocking agents: linked to respiratory failure, mechanical ventilation, steroids; primarily motor deficit; myopathic changes on EMG; good recovery (weeks). Recent use of sedatives over blockers has reduced incidence.
  • Both conditions can complicate ventilator weaning and prolong ICU stays, increasing risks. While recovery is often favorable, sequelae can occur.

    • Impact:

    • Understanding these neuromuscular complications aids in timely diagnosis and appropriate management strategies.
    • Distinguishing between the two conditions is crucial for predicting patient outcomes and guiding rehabilitation.
    • Reduced use of neuromuscular blockers in favor of sedatives has shown promise in decreasing the incidence of related neuromuscular disorders.