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Critical illness myopathy and neuropathy
N Latronico1, F Fenzi, D Recupero
1Instituto di Anestesia-Rianimazione, Spedali Civili, Università di Brescia, Italy.
Lancet (London, England)
|June 8, 1996
Summary
Critically ill comatose patients can develop paralysis due to neuromuscular disorders (NMD). Early diagnosis with electroneuromyography (ENMG) is crucial for management and prognosis, even in severe sepsis cases.
Area of Science:
- Neurology
- Critical Care Medicine
- Pathology
Background:
- Critically ill patients with sepsis and multiple-organ failure can experience paralysis.
- Peripheral nerve and muscle disorders (NMD) are a potential cause of paralysis in these patients.
Purpose of the Study:
- To investigate neuromuscular disorders (NMD) in comatose patients with paralysis.
- To determine the diagnostic value of electroneuromyography (ENMG) and muscle-nerve biopsy.
Main Methods:
- Electroneuromyography (ENMG) and muscle-nerve biopsy were performed on comatose patients with paralysis and absent deep-tendon reflexes.
- Clinical data including sepsis duration, organ dysfunction, biochemical markers, and medications were recorded.
Main Results:
- 24 patients developed quadriparesis or quadriplegia, with muscle changes in 23.
- Axonal neuropathy was identified in 8 of 22 patients.
- While sepsis and organ dysfunction were common, specific drugs were not definitively linked to paralysis, and the role of hyperglycemia/hypoalbuminemia was unclear.
Conclusions:
- Comatose patients can experience complete paralysis due to NMD.
- ENMG is essential for diagnosing NMD in critical care, guiding management, and avoiding unnecessary tests.
- Muscle-nerve biopsy is reserved for cases requiring specific NMD classification.