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Critical illness myopathy is frequent: accompanying neuropathy protracts ICU discharge
  1. Susanne Koch1,
  2. Simone Spuler2,
  3. Maria Deja1,
  4. Jeffrey Bierbrauer1,
  5. Anna Dimroth1,
  6. Friedrich Behse3,
  7. Claudia D Spies1,
  8. Klaus-D Wernecke4,
  9. Steffen Weber-Carstens1
  1. 1Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
  2. 2Muscle Research Unit, Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
  3. 3Department of Neurology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
  4. 4Institute of Medical Biometry, Charité-Universitätsmedizin Berlin, Sostana GmbH, Berlin, Germany
  1. Correspondence to Dr Susanne Koch, Department of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Mitte, Augustenburger Platz 1, Berlin D-13353, Germany; susanne.koch{at}charite.de

Abstract

Objectives Neuromuscular dysfunction in critically ill patients is attributed to either critical illness myopathy (CIM) or critical illness polyneuropathy (CIP) or a combination of both. However, it is unknown whether differential diagnosis has an impact on prognosis. This study investigates whether there is an association between the early differentiation of CIM versus CIP and clinical prognosis.

Methods The authors included mechanically ventilated patients who featured a Simplified Acute Physiology Score II (SAPS-II) ≥20 on three consecutive days within the first week after intensive care unit (ICU) admission. Fifty-three critically ill patients were enrolled and examined by conventional nerve-conduction studies and direct muscle stimulation (184 examinations in total). The first examination was conducted within the first week after admission to the ICU.

Results In this cohort of critically ill patients, CIM was more frequent (68%) than CIP (38%). Electrophysiological signs of CIM preceded electrophysiological signs of CIP (median at day 7 in CIM patients vs day 10 in CIP patients, p<0.001). Most patients with CIP featured concomitant CIM. At discharge from ICU, 25% of patients with isolated CIM showed electrophysiological signs of recovery and significantly lower degrees of weakness. Recovery could not be observed in patients with combined CIM/CIP, even though the ICU length of stay was significantly longer (mean 35 days in CIM/CIP vs mean 19 days in CIM, p<0.001).

Conclusion Prognoses of patients differ depending on electrophysiological findings during early critical illness: early electrophysiological differentiation of ICU acquired neuromuscular disorder enhances the evaluation of clinical prognosis during critical illness.

  • Critical illness myopathy
  • critical illness polyneuropathy
  • direct muscle stimulation
  • intensive care unit
  • clinical neurology
  • intensive care
  • motor neuron disease
  • myopathy
  • neuropathy
  • Received 27 August 2009
  • Revised 3 June 2010
  • Accepted 23 June 2010

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Footnotes

  • Funding Deutsche Forschungsgemeinschaft.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Local Ethics Committee Charité, Berlin.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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