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Nerve excitability changes in critical illness polyneuropathy.

W J Z'Graggen1, C S Y Lin, R S Howard

  • 1Sobell Department of Neurophysiology, Institute of Neurology, London, UK.

Brain : a Journal of Neurology
|August 12, 2006
PubMed
Summary

Critical illness polyneuropathy (CIP) causes muscle weakness in ICU patients. Nerve excitability tests reveal motor axons are depolarized due to factors like high potassium and poor blood flow, contributing to neuropathy.

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Area of Science:

  • Neurology
  • Intensive Care Medicine
  • Electrophysiology

Background:

  • Critical illness polyneuropathy (CIP) is a common complication in intensive care units (ICUs).
  • CIP leads to muscle weakness and atrophy, prolonging mechanical ventilation and increasing mortality.
  • The underlying mechanisms and effective treatments for CIP remain poorly understood.

Purpose of the Study:

  • To investigate axonal membrane property changes in CIP using nerve excitability testing.
  • To identify electrophysiological alterations associated with CIP in ICU patients.

Main Methods:

  • Nerve excitability testing was performed on ten patients with electrophysiologically confirmed CIP.
  • Median nerve stimulation and compound action potential recordings were used.

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  • Parameters measured included strength-duration time constant, threshold electrotonus, current-threshold relationship, and recovery cycle.

    • Main Results:

    • CIP patients showed reduced superexcitability and increased accommodation, indicating axonal membrane depolarization.
    • Reduced superexcitability was observed in patients with and without renal failure.
    • In renal failure patients, reduced superexcitability correlated with serum potassium; in others, depolarization correlated with respiratory acidosis.

    Conclusions:

    • Motor axons in CIP patients are depolarized, potentially due to hyperkalemia and hypoperfusion.
    • This chronic membrane depolarization may play a role in the development of critical illness polyneuropathy.
    • Nerve excitability testing provides insights into the pathophysiology of CIP.