Intensive Care Unit-Acquired Weakness in Children: A Prospective Observational Study Using Simplified Serial...

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.