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Intensive care unit acquired weakness in children: Critical illness polyneuropathy and myopathy
Vinay Kukreti1, Mosharraf Shamim2, Praveen Khilnani3
1Departments of Critical Care, Pediatric Critical Care Unit, The Hospital for Sick Children, Toronto, Canada.
Insights
Intensive care unit acquired weakness (ICUAW) in children, caused by critical illness polyneuropathy (CIP) or myopathy (CIM), is poorly understood. Further research is needed to determine its incidence, causes, and long-term effects in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Neuromuscular disorders
Background:
- Intensive care unit acquired weakness (ICUAW) is common in critically ill patients, often due to critical illness polyneuropathy (CIP) or myopathy (CIM).
- Improved survival rates and treatments like steroids and muscle relaxants contribute to ICUAW.
- While CIP and CIM are reported in children, their prevalence and impact in this population are not well-established.
Purpose of the Study:
- To review the current understanding of CIP and CIM pathophysiology, clinical presentation, diagnosis, and treatment.
- To specifically focus on the pediatric age group regarding these conditions.
Main Methods:
- Literature search using MedLine and Embase databases.
- Inclusion of both adult and pediatric studies relevant to CIP and CIM.
Main Results:
- ICUAW in children is an under-described condition.
- Key aspects like incidence, etiology, and long-term prognosis remain largely unknown.
Conclusions:
- Critical illness polyneuropathy and myopathy are infrequent but significant conditions in critically ill children.
- These neuromuscular complications stem from multifactorial origins and impact patient morbidity, ICU stay duration, and potentially mortality.
Background And Aims:
Intensive care unit acquired weakness (ICUAW) is a common occurrence in patients who are critically ill. It is most often due to critical illness polyneuropathy (CIP) or to critical illness myopathy (CIM). ICUAW is increasingly being recognized partly as a consequence of improved survival in patients with severe sepsis and multi-organ failure, partly related to commonly used agents such as steroids and muscle relaxants. There have been occasional reports of CIP and CIM in children, but little is known about their prevalence or clinical impact in the pediatric population. This review summarizes the current understanding of pathophysiology, clinical presentation, diagnosis and treatment of CIP and CIM in general with special reference to published literature in the pediatric age group.
Subjects And Methods:
Studies were identified through MedLine and Embase using relevant MeSH and Key words. Both adult and pediatric studies were included.
Results:
ICUAW in children is a poorly described entity with unknown incidence, etiology and unclear long-term prognosis.
Conclusions:
Critical illness polyneuropathy and myopathy is relatively rare, but clinically significant sequelae of multifactorial origin affecting morbidity, length of intensive care unit (ICU) stay and possibly mortality in critically ill children admitted to pediatric ICU.
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