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Patterns of neurophysiological abnormality in prolonged critical illness
J H Coakley1, K Nagendran, G D Yarwood
1Department of Intensive Care, St. Bartholomew's Hospital, West Smithfield, London, UK.
Intensive Care Medicine
|October 3, 1998
Summary
Critically ill patients often develop neurophysiological abnormalities, including sensory, motor, or mixed patterns. Understanding these patterns is key to addressing neuromuscular weakness in critical care.
Area of Science:
- Neurology
- Intensive Care Medicine
- Neurophysiology
Background:
- Prolonged critical illness can lead to complex neurophysiological abnormalities.
- Neuromuscular weakness is a common complication in intensive care unit (ICU) survivors.
Purpose of the Study:
- To characterize neurophysiological abnormalities in prolonged critical illness.
- To identify potential etiological factors contributing to these abnormalities.
Main Methods:
- Prospective case series involving 44 critically ill patients (ICU stay > 7 days).
- Utilized neurophysiological studies, severity of illness scores, organ failure assessments, drug therapy review, and muscle biopsies.
- Analyzed outcomes including hospital mortality.
Main Results:
- Identified five groups of neurophysiological abnormalities: normal (7 patients), sensory axonal neuropathy (4), pure motor syndrome (11), mixed motor/sensory (19), and unclassified (3).
- No clear correlation found between neurophysiological patterns and APACHE II scores, organ failure, sepsis, or specific drug therapies (steroids, muscle relaxants).
- Muscle biopsy findings showed diverse histological changes, with normal muscle only in patients with normal neurophysiology.
Conclusions:
- Neurophysiological abnormalities in critical illness present as sensory, motor, or mixed disturbances.
- The motor syndrome may involve distal axon, neuromuscular junction, or muscle membrane issues.
- Mixed disturbances, characteristic of critical illness polyneuropathy, combine motor and sensory deficits, necessitating further research for prevention and treatment.