[Neuromuscular manifestations in critically ill patients]

Critically-ill patients in intensive care units often suffer from weakness of the arms and legs and have difficulty in weaning from the ventilator. If this cannot be explained by the illness itself, it may be due to a critical illness polyneuropathy (CIP) or a critical illness myopathy (CIM) or both. It is difficult to determine the cause of the weakness by conventional methods in an intensive care unit. The objective was to describe the diagnostic yield with electrodiagnostic testing and describe the various patterns and prognosis in these patients.

55 consecutive patients with a critical illness associated with unexplained weakness of limbs and often respiratory muscles were studied to estimate motor and sensory nerve conduction, electromyography, direct muscle stimulation, and repetitive nerve stimulation.

18 patients had CIM, 16 had CIP and in 9 a combination of CIM and CIP was found. Direct muscle stimulation was more sensitive to show myogenic affection than needle EMG in this patient group.

Electrophysiologic tests are valuable in identifying the specific cause of prolonged weakness in critically-ill patients in intensive care units.