Neuromuscular dysfunction acquired in critical illness: a systematic review

Area of Science:

• Critical care medicine
• Neurology
• Intensive care unit (ICU) research

Background:

• Critical illness neuromuscular abnormalities (CINMA) are common complications in intensive care units.
• Understanding CINMA prevalence, risk factors, and outcomes is crucial for patient management.

Purpose of the Study:

• To systematically review the prevalence, risk factors, and outcomes associated with CINMA in adult ICU patients.
• To identify factors contributing to CINMA and its impact on patient prognosis.

Main Methods:

• A systematic review of studies evaluating CINMA in adult ICU patients using clinical and electrophysiological assessments.
• Inclusion of studies with sufficient data to quantify associations between CINMA and exposures/outcomes.
• Databases searched included MEDLINE, EMBASE, CINAHL, and the Cochrane Library.

Main Results:

• CINMA was diagnosed in 46% of 1421 adult ICU patients across 24 studies, primarily those with sepsis, multi-organ failure, or prolonged mechanical ventilation.
• Associated risk factors included hyperglycemia (especially without tight glycemic control), systemic inflammatory response syndrome, sepsis, multiple organ dysfunction, renal replacement therapy, and catecholamine administration.
• No consistent relationships were found with age, gender, illness severity, or use of glucocorticoids, neuromuscular blockers, aminoglycosides, or midazolam. Prolonged mechanical ventilation and ICU/hospital stays were observed, but unadjusted mortality was not consistently increased.

Conclusions:

• CINMA affects nearly half of critically ill ICU patients with sepsis, multi-organ failure, or prolonged mechanical ventilation.
• The link between CINMA and commonly cited risk factors like glucocorticoids and neuromuscular blockers, as well as short-term survival, requires further investigation.
• Glycemic control emerges as a potential modifiable factor to mitigate CINMA risk.