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Small nerve fiber pathology in critical illness
Nicola Latronico1, Massimiliano Filosto, Nazzareno Fagoni
1Department of Anesthesia and Critical Care Medicine, Section of Neuroanesthesia and Neurocritical Care, University of Brescia at Spedali Civili, Brescia, Italy.
Plos One
|October 8, 2013
Summary
Critical illness can cause small fiber neuropathy, leading to nerve fiber degeneration. This may explain sensory loss and pain in intensive care survivors.
Area of Science:
- Neurology
- Critical Care Medicine
- Pathology
Background:
- Small fiber neuropathy is characterized by intraepidermal nerve fiber (IENF) degeneration, often causing neuropathic pain.
- The impact of critical illness on IENF has not been previously established.
Purpose of the Study:
- To investigate whether critical illness affects intraepidermal nerve fibers (IENF) in neurocritical care patients.
- To assess the relationship between critical illness, IENF degeneration, and subsequent neurological symptoms.
Main Methods:
- 14 neurocritical care patients with prolonged ICU stays underwent neurological exams, nerve conduction studies, and skin biopsies.
- IENF and sweat gland innervation density were quantified during ICU stay and at follow-up.
- Patient outcomes including infection, sepsis, and organ failure were recorded.
Main Results:
- 93% of patients experienced infections, sepsis, or multiple organ failure.
- All patients exhibited severe loss of IENF and reduced sweat gland innervation.
- Follow-up revealed sensory loss, burning pain, and clinical dysautonomia in several patients.
Conclusions:
- Small fiber pathology can manifest during acute critical illness.
- This pathology may contribute to chronic sensory deficits and pain in survivors of critical care.
- Further research is needed to understand the long-term disability impact in broader critical care populations.
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