Intensive Care Unit-Acquired Weakness in Children: A Prospective Observational Study Using Simplified Serial Electrophysiological Testing (PEDCIMP Study)
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Ananthanarayanan Kasinathan1,2, Indar Kumar Sharawat1,3, Pratibha Singhi1,4
1Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
Insights
Pediatric Critical Illness Myopathy Polyneuropathy (PEDCIMP) study found a very low incidence of intensive care unit-acquired weakness in children with high Pediatric Risk of Mortality scores. Serial electrophysiological testing showed minimal cases, indicating a favorable prognosis for this group.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Intensive care research
Background:
- Intensive care unit-acquired weakness (ICUAW) is a significant concern in critically ill children.
- Understanding the incidence and onset of ICUAW is crucial for improving patient outcomes.
- Pediatric critical illness myopathy and polyneuropathy are key components of ICUAW.
Purpose of the Study:
- To determine the incidence and time of onset of intensive care unit-acquired weakness (ICUAW) in children aged 2-12 years.
- To utilize serial simplified electrophysiological assessments for monitoring ICUAW.
- To investigate ICUAW in a prospective cohort using the Pediatric Critical Illness Myopathy Polyneuropathy (PEDCIMP) study protocol.
Main Methods:
- A prospective, single-center cohort study (PEDCIMP2016) was conducted in a tertiary care pediatric intensive care unit.
- Children aged 2-12 years with Pediatric Risk of Mortality (PRISM) score > 20 and > 24-hour ICU stay underwent baseline and serial electrophysiological evaluations.
- Simplified electrophysiological testing of the common peroneal and sural nerves was performed every other day, with a >25% reduction in CMAP or SNAP considered significant for ICUAW.
Main Results:
- Out of 97 enrolled children, sepsis was the most common reason for admission (81%).
- No significant decrease (>25%) in compound muscle action potential (CMAP) of the common peroneal nerve was detected in 380 electrophysiological observations.
- Two children, initially unfit for inclusion, were diagnosed with ICUAW during the study period.
Conclusions:
- Children admitted to the ICU with a PRISM score > 20 exhibit a very low incidence of intensive care unit-acquired weakness.
- Serial clinical and abbreviated electrophysiological evaluations appear effective in assessing ICUAW in this pediatric population.
- The findings suggest a potentially better prognosis regarding ICUAW for critically ill children with high PRISM scores.
Background:
To study the incidence and time of onset of intensive care unit-acquired weakness in a prospective cohort of children (2-12 years) by serial simplified electrophysiological assessment (Pediatric Critical Illness Myopathy Polyneuropathy study, PEDCIMP).
Methods:
A single-center, prospective cohort study (Trial Registry Number: NCT02763709; PEDCIMP2016) was conducted at the pediatric intensive care unit of a tertiary care hospital in North India. A complete electrophysiological evaluation (4 motor nerves and 2 sensory nerves) was performed at baseline in children (2-12 years) admitted to the ICU with a pediatric risk of mortality (PRISM) of > 20 with more than 24-h stay. Following the entry evaluation, a minimal alternate day simplified electrophysiological testing of the unilateral common peroneal nerve and the sural nerve was assessed. A 25% reduction in compound muscle action potential (CMAP) and sensory nerve action potential from baseline was considered significant for ICUAW and was confirmed by complete electrophysiological re-evaluation.
Results:
Of the total 481 children assessed for eligibility, 97 were enrolled. The median age of the cohort was 7 years. Sepsis (81%); need for vasoactive support (43%); multiorgan dysfunction (26%) were the common reasons for admission. Of the 433 eligible patient ICU days, 380 electrophysiological observations were done. A significant decrease of > 25% in CMAP of common peroneal nerve was not detected in any of the 380 observations. However, two children unfit for inclusion were diagnosed with ICUAW during the study period.
Conclusions:
Children admitted with PRISM > 20 have a very low incidence of intensive care unit-acquired weakness by serial clinical and abbreviated electrophysiological evaluation.
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