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Critical illness myopathy neuropathy

Sarah E Jolley, Aaron Bunnell, Catherine L Hough
Survivorship after critical illness is an increasingly important health care concern as intensive unit care (ICU) utilization continues to increase while ICU mortality is decreasing. Critical illness survivors experience marked disability and impairments in physical and cognitive function that persist for years after their initial ICU stay(1-7). Newfound impairment is associated with increased healthcare costs and utilization, reductions in health related quality of life and prolonged unemployment(5,8,9). Weakness, critical illness neuropathy and/or myopathy, and muscle atrophy are common in critically ill patients with up to 80% of patients admitted to the ICU developing some form of neuromuscular dysunction(1,10,11)...
April 7, 2016: Chest
Aida Field-Ridley, Madan Dharmar, David Steinhorn, Craig McDonald, James P Marcin
OBJECTIVE: ICU-acquired weakness, comprised critical illness myopathy and critical illness neuropathy, occurs in a significant proportion of critically ill adults and is associated with high morbidity and mortality. Little is known about ICU-acquired weakness among critically ill children. We investigated the incidence of ICU-acquired weakness among PICUs participating in the Virtual PICU Systems database. We also sought to identify associated risk factors for ICU-acquired weakness and evaluate the hypothesis that ICU-acquired weakness is associated with poor clinical outcomes...
January 2016: Pediatric Critical Care Medicine
Luan Nguyen The, Cong Nguyen Huu
INTRODUCTION: Critical illness polyneuropathy, myopathy and polyneuromyopathy, grouped under the term CIP/CIM, share several risk factors and are associated with debilitating outcomes. OBJECTIVE: To assess the incidence and distribution of CIP/CIM subtypes and evaluate the risk factors and outcomes of CIP/CIM in a rural hospital in Vietnam. METHOD: One hundred and thirty three critically ill patients treated more than ten days in the ICU were enrolled...
October 15, 2015: Journal of the Neurological Sciences
Greet Hermans, Greet Van den Berghe
A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as "intensive care unit acquired weakness" (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy...
2015: Critical Care: the Official Journal of the Critical Care Forum
J Mehrholz, M Pohl, J Kugler, J Burridge, S Mückel, B Elsner
Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living. Our primary objective was to assess the effects of physical rehabilitation therapies and interventions for people with CIP and CIM in improving activities of daily living such as walking, bathing, dressing and eating...
October 2015: European Journal of Physical and Rehabilitation Medicine
O Friedrich, M B Reid, G Van den Berghe, I Vanhorebeek, G Hermans, M M Rich, L Larsson
Critical illness polyneuropathies (CIP) and myopathies (CIM) are common complications of critical illness. Several weakness syndromes are summarized under the term intensive care unit-acquired weakness (ICUAW). We propose a classification of different ICUAW forms (CIM, CIP, sepsis-induced, steroid-denervation myopathy) and pathophysiological mechanisms from clinical and animal model data. Triggers include sepsis, mechanical ventilation, muscle unloading, steroid treatment, or denervation. Some ICUAW forms require stringent diagnostic features; CIM is marked by membrane hypoexcitability, severe atrophy, preferential myosin loss, ultrastructural alterations, and inadequate autophagy activation while myopathies in pure sepsis do not reproduce marked myosin loss...
July 2015: Physiological Reviews
Hyung Chung, Kyung-Lim Joa, Hyo-Sang Kim, Chang-Hwan Kim, Han-Young Jung, Myeong Ok Kim
Acute transverse myelitis (ATM) is an upper motor neuron disease of the spinal cord, and concomitant association of peripheral polyneuropathy, particularly the axonal type, is rarely reported in children. Our cases presented with ATM complicated with axonal type polyneuropathy. Axonal type polyneuropathy may be caused by acute motor-sensory axonal neuropathy (AMSAN) or critical illness polyneuropathy and myopathy (CIPNM). These cases emphasize the need for nerve and muscle biopsies to make the differential diagnosis between AMSAN and CIPNM in patients with ATM complicated with axonal polyneuropathy...
February 2015: Annals of Rehabilitation Medicine
Jan Mehrholz, Marcus Pohl, Joachim Kugler, Jane Burridge, Simone Mückel, Bernhard Elsner
BACKGROUND: Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living. OBJECTIVES: Our primary objective was to assess the effects of physical rehabilitation therapies and interventions for people with CIP and CIM in improving activities of daily living such as walking, bathing, dressing and eating...
2015: Cochrane Database of Systematic Reviews
Nicola Latronico, Giovanni Nattino, Bruno Guarneri, Nazzareno Fagoni, Aldo Amantini, Guido Bertolini
OBJECTIVES: To evaluate the accuracy of the peroneal nerve test (PENT) in the diagnosis of critical illness polyneuropathy (CIP) and myopathy (CIM) in the intensive care unit (ICU). We hypothesised that abnormal reduction of peroneal compound muscle action potential (CMAP) amplitude predicts CIP/CIM diagnosed using a complete nerve conduction study and electromyography (NCS-EMG) as a reference diagnostic standard. DESIGN: prospective observational study. SETTING: Nine Italian ICUs...
2014: F1000Research
Miroslav Skorna, Roman Kopacik, Eva Vlckova, Blanka Adamova, Milena Kostalova, Josef Bednarik
INTRODUCTION: Small-fiber pathology can develop in the acute phase of critical illness and may explain chronic sensory impairment and pain in critical care survivors. METHODS: Eleven adult ischemic stroke patients in a neurocritical care unit were enrolled in an observational cohort study. Intraepidermal nerve fiber density (IENFD) in the distal leg was assessed on admission to the intensive care unit and 10-14 days later, together with electrophysiological testing...
July 2015: Muscle & Nerve
M B Muthuswamy, B N Thomas, D Williams, J Dingley
PURPOSE: Patients recovering from critical illness especially those with critical illness related neuropathy, myopathy, or burns to face, arms and hands are often unable to communicate by writing, speech (due to tracheostomy) or lip reading. This may frustrate both patient and staff. Two low cost movement tracking systems based around a laptop webcam and a laser/optical gaming system sensor were utilised as control inputs for on-screen text creation software and both were evaluated as communication tools in volunteers...
September 2014: Burns: Journal of the International Society for Burn Injuries
Zohar Argov, Nicola Latronico
Increased survival of critically ill patients has focused the attention on secondary complications of intensive care unit (ICU) stay, mainly ICU-acquired weakness (ICUAW). ICUAW is relatively common with significant impact on recovery. Prolonging mechanical ventilation and overall hospitalization time, increased mortality, and persistent disability are the main problems associated with ICUAW. The chapter deals mainly with the differential diagnosis of neuromuscular generalized weakness that develops in the ICU, but focal ICUAW is reviewed too...
2014: Handbook of Clinical Neurology
Xiao-Ke Wang, Hong-Liang Zhang, Jie Zhu
No abstract text is available yet for this article.
April 2013: Journal of Neurosurgery. Spine
Claudia C Dos Santos, Jane Batt
PURPOSE OF REVIEW: ICU-acquired weakness (ICUAW) is now recognized as a major complication of critical illness. There is no doubt that ICUAW is prevalent - some might argue ubiquitous - after critical illness, but its true role, the interaction with preexisting nerve and muscle lesions as well as its contribution to long-term functional disability, remains to be elucidated. RECENT FINDINGS: In this article, we review the current state-of-the-art of the basic pathophysiology of nerve and muscle weakness after critical illness and explore the current literature on ICUAW with a special emphasis on the most important mechanisms of weakness...
October 2012: Current Opinion in Critical Care
Alexander Semmler, Torsten Okulla, Markus Kaiser, Burkhardt Seifert, Michael T Heneka
In this observational study, we analyzed the long-term neuromuscular deficits of survivors of critical illness. Intensive care unit-acquired muscular weakness (ICU-AW) is a very common complication of critical illness. Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) are two main contributors to ICU-AW. ICU-AW is associated with an increased mortality and leads to rehabilitation problems. However, the long-term outcome of ICU-AW and factors influencing it are not well known. We analyzed the medical records of 490 survivors of critical illness, aged 18-75 years and located in the area of the study center...
January 2013: Journal of Neurology
Patrícia Dos Santos, Cassiano Teixeira, Augusto Savi, Juçara Gasparetto Maccari, Fernanda Santos Neres, André Sant Ana Machado, Roselaine Pinheiro de Oliveira, Marlise Ribeiro, Francisco T Rotta
BACKGROUND: Critical illness myopathy and/or neuropathy (CRIMYNE) is a common alteration seen in the ICU. The currently available bedside methods of measuring respiratory and peripheral muscle function in critically ill patients are somewhat inadequate. The objective of this study was to evaluate the presence of diaphragmatic and peripheral CRIMYNE in septic patients with prolonged weaning from mechanical ventilation (MV). METHODS: Cohort prospective study with an entry period of 6 months...
October 2012: Respiratory Care
P Baum, S Bercker, T Villmann, J Classen, W Hermann
BACKGROUND: Critical Illness Myopathy and Neuropathy (CRIMYN) frequently coexist with severe sepsis and is associated with prolonged weaning from mechanical ventilation and prolonged ICU length of stay. We aimed to classify different levels as well as patterns of impairment with regard to electrophysiological disturbances in CRIMYN patients by cluster analysis. METHODS: A total of 30 patients with sepsis/SIRS were studied prospectively. Motor and sensory conduction studies were performed from six motor and four sensory nerves on a weekly basis from admission until discharge and finally after 6 months...
April 2011: Der Nervenarzt
Jasvinder Chawla, Gregory Gruener
A syndrome of generalized weakness, areflexia, and difficulty with weaning from a ventilator is a common clinical presentation in the critically ill patient, especially in the setting of sepsis, multiorgan failure, and hyperglycemia. At first believed to be a manifestation of nerve (critical illness neuropathy, CIN) or muscle (critical illness myopathy, CIM) dysfunction, our current conceptualization is as a spectrum (critical illness neuromuscular abnormalities, CINMA) that varies in extent and site(s) of involvement, but often a similar clinical presentation...
November 2010: Neurologic Clinics
Susanne Koch, Simone Spuler, Maria Deja, Jeffrey Bierbrauer, Anna Dimroth, Friedrich Behse, Claudia D Spies, Klaus-D Wernecke, Steffen Weber-Carstens
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...
March 2011: Journal of Neurology, Neurosurgery, and Psychiatry
José Fernández-Lorente, Angel Esteban, Emilio Salinero, Alfredo Traba, Julio Prieto, Eduardo Palencia
INTRODUCTION: Critical illness patients may show marked weakness acquired in the Intensive Care Unit (ICU). There are some disagreements about the myopathic versus neuropathic damage in this condition, presumably due to the lack of reliable diagnostic criteria. AIMS: To report the neurophysiological findings in critical patients, to classify them in groups according to the electro-physiological data of myopathy, and to ascertain the rapport between the neurophysiological classification of myopathy and the muscle biopsy results...
June 16, 2010: Revista de Neurologia
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