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Critical Illness Polyneuropathy

Jan Mehrholz, Simone Thomas, Jane H Burridge, André Schmidt, Bettina Scheffler, Ralph Schellin, Stefan Rückriem, Daniel Meißner, Katja Mehrholz, Wolfgang Sauter, Ulf Bodechtel, Bernhard Elsner
BACKGROUND: Critical illness myopathy (CIM) and polyneuropathy (CIP) are a common complication of critical illness. Both cause intensive-care-unit-acquired (ICU-acquired) muscle weakness (ICUAW) which increases morbidity and delays rehabilitation and recovery of activities of daily living such as walking ability. Focused physical rehabilitation of people with ICUAW is, therefore, of great importance at both an individual and a societal level. A recent systematic Cochrane review found no randomised controlled trials (RCT), and thus no supporting evidence, for physical rehabilitation interventions for people with defined CIP and CIM to improve activities of daily living...
November 24, 2016: Trials
Mitsuru Ikeno, Shinpei Abe, Hirokazu Kurahashi, Michihiko Takasu, Toshiaki Shimizu, Akihisa Okumura
The outcome of mild encephalitis/encephalopathy with reversible splenial lesion (MERS) is favorable whether or not specific treatment is performed. We report a patient with MERS treated with methylprednisolone, complicated by gastric perforation followed by critical illness polyneuropathy. The patient was a 14-year-old male with mildly impaired consciousness and hyponatremia who was treated with methylprednisolone pulse therapy. High fever appeared after methylprednisolone pulse therapy and free air was recognized on an abdomen roentgenogram...
November 14, 2016: Brain & Development
Arisa Miura, Hirofumi Hino, Kazuhide Uchida, Soichiro Inoue, Takeshi Tateda
PURPOSE: The pathological mechanisms of critical illness polyneuropathy (CIP), an acute neuromuscular disorder, remain unknown. In this study, we evaluated nerve and vascular properties that might account for electrophysiological abnormalities, including reduced nerve conduction amplitude, in the early phase of CIP. METHODS: Rats were administered intravenous saline (C-group; n = 31) or lipopolysaccharide (3 mg/kg/day; L-group; n = 30) for 48 h. Subsequently, tracheotomy was performed and sciatic nerves exposed bilaterally...
September 9, 2016: Journal of Anesthesia
David R Price, Mark E Mikkelsen, Craig A Umscheid, Ehrin J Armstrong
OBJECTIVE: The relationship between neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness remains unclear. We examined the association between neuromuscular blocking agents and ICU-acquired weakness, critical illness polyneuropathy, and critical illness myopathy. DATA SOURCES: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and bibliographies of included studies were searched from database inception until September 24, 2015...
November 2016: Critical Care Medicine
Nicola Latronico
No abstract text is available yet for this article.
August 8, 2016: Intensive Care Medicine
V B Voytenkov, A V Klimkin, N V Skripchenko, A A Vil'nits, A I Konev, G P Ivanova
14 pediatric critically ill patients with various infectious pathologies were assessed. Electroneuromyography was carried out in all patients. Polyneuropathy of critical states were revealed in 10 children. It is shown that the frequency of severeform of this state was 40%. Polyneuropathy mostly affects the peripheral nerves of the lower extremities. Polyneuropathy developed typically on 5-7 day from the start of mechanical ventilation.
March 2016: Anesteziologiia i Reanimatologiia
Salil Gupta, Mayank Mishra
BACKGROUND: Critical illness polyneuropathy (CIP) is a common complication of severe sepsis and systemic inflammatory response syndrome (SIRS). The risk factors for sepsis-induced CIP have not been well established. AIM: The aim of this study was to find out the risk factors of sepsis-induced CIP, especially its relationship with the severity of illness. PATIENTS AND METHODS: A cohort of 100 patients with sepsis defined as SIRS of proven or presumed microbial etiology were followed up with nerve conduction studies (NCS) performed within the first 14 days of admission...
July 2016: Neurology India
Pooja Prathapan Sarada, Krishnaswamy Sundararajan
Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy, usually evoked by antecedent infection. Sarcoidosis is a multisystem chronic granulomatous disorder with neurological involvement occurring in a minority. We present a case of a 43-year-old Caucasian man who presented with acute ascending polyradiculoneuropathy with a recent diagnosis of pulmonary sarcoidosis. The absence of acute flaccid paralysis excluded a clinical diagnosis of GBS in the first instance. Subsequently, a rapid onset of proximal weakness with multi-organ failure led to the diagnosis of GBS, which necessitated intravenous immunoglobulin and plasmapheresis to which the patient responded adequately, and he was subsequently discharged home...
April 2016: Indian Journal of Critical Care Medicine
Hussein Algahtani, Ahmad Subahi, Bader Shirah
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was first discovered in September 2012 in Saudi Arabia. Since then, it caused more than 1600 laboratory-confirmed cases and more than 580 deaths among them. The clinical course of the disease ranges from asymptomatic infection to severe lower respiratory tract illness with multiorgan involvement and death. The disease can cause pulmonary, renal, hematological, and gastrointestinal complications. In this paper, we report neurological complications of MERS-CoV in two adult patients, and we hypothesize the pathophysiology...
2016: Case Reports in Neurological Medicine
Bronwen Connolly, Brenda O'Neill, Lisa Salisbury, Bronagh Blackwood
BACKGROUND: Physical rehabilitation interventions aim to ameliorate the effects of critical illness-associated muscle dysfunction in survivors. We conducted an overview of systematic reviews (SR) evaluating the effect of these interventions across the continuum of recovery. METHODS: Six electronic databases (Cochrane Library, CENTRAL, DARE, Medline, Embase, and Cinahl) were searched. Two review authors independently screened articles for eligibility and conducted data extraction and quality appraisal...
October 2016: Thorax
Susanne Koch, Jeffrey Bierbrauer, Kurt Haas, Simone Wolter, Julian Grosskreutz, Friedrich C Luft, Claudia D Spies, Jens Fielitz, Steffen Weber-Carstens
BACKGROUND: Reduced motor and sensory nerve amplitudes in critical illness polyneuropathy (CIP) are characteristic features described in electrophysiological studies and due to dysfunction of voltage-gated sodium channels. Yet, faulty membrane depolarization as reported in various tissues of critically ill patients may cause reduced membrane excitability as well. The aim of this study was to compare the pathophysiological differences in motor nerve membrane polarization and voltage-gated sodium channel function between CIP patients and critically ill patients not developing CIP during their ICU stay (ICU controls)...
December 2016: Intensive Care Medicine Experimental
T H P Draak, K C Gorson, E K Vanhoutte, S I van Nes, P A van Doorn, D R Cornblath, L H van den Berg, C G Faber, I S J Merkies
BACKGROUND AND PURPOSE: There is increasing interest in using patient-reported outcome measures (PROMs) in clinical studies to capture individual changes over time. However, PROMs have also been criticized because they are entirely subjective. Our objective was to examine the relationship between a subjective PROM and an objective outcome tool in patients with Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and gammopathy-related polyneuropathy (MGUSP)...
July 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Margaret S Herridge, Marc Moss, Catherine L Hough, Ramona O Hopkins, Todd W Rice, O Joseph Bienvenu, Elie Azoulay
Outcomes after acute respiratory distress syndrome (ARDS) are similar to those of other survivors of critical illness and largely affect the nerve, muscle, and central nervous system but also include a constellation of varied physical devastations ranging from contractures and frozen joints to tooth loss and cosmesis. Compromised quality of life is related to a spectrum of impairment of physical, social, emotional, and neurocognitive function and to a much lesser extent discrete pulmonary disability. Intensive care unit-acquired weakness (ICUAW) is ubiquitous and includes contributions from both critical illness polyneuropathy and myopathy, and recovery from these lesions may be incomplete at 5 years after ICU discharge...
May 2016: Intensive Care Medicine
Hubertus Axer, Alexander Grimm, Christine Pausch, Ulrike Teschner, Jan Zinke, Sven Eisenach, Sindy Beck, Orlando Guntinas-Lichius, Frank M Brunkhorst, Otto W Witte
BACKGROUND: A decrease of small nerve fibers in skin biopsies during the course of critical illness has been demonstrated recently. However, the diagnostic use of skin biopsies in sepsis and its time course is not known. METHODS: Patients (n=32) with severe sepsis or septic shock were examined using skin biopsies, neurological examination, nerve conduction studies, and sympathetic skin response in the first week after onset of sepsis, 2 weeks and 4 months later and compared to gender- and age-matched healthy controls...
March 15, 2016: Critical Care: the Official Journal of the Critical Care Forum
Stephen J Shepherd, Richard Newman, Stephen J Brett, David M Griffith
OBJECTIVES: ICU-acquired weakness is a common complication of critical illness and can have significant effects upon functional status and quality of life. As part of preliminary work to inform the design of a randomized trial of a complex intervention to improve recovery from critical illness, we sought to identify pharmacological interventions that may play a role in this area. DATA SOURCES: We systematically reviewed the published literature relating to pharmacological intervention for the treatment and prevention of ICU-acquired weakness...
June 2016: Critical Care Medicine
R Kollmar
Intensive care unit acquired weakness (ICUAW) is a frequent and severe complication of intensive care management. Within ICUAW critical illness polyneuropathy (CIP) and myopathy (CIM) can be differentiated. The major symptom of ICUAW is progressive quadriparesis, which makes weaning from the respirator more difficult, can appear early after admission to an ICU and can often be detected several months after discharge from the ICU. The pathophysiology of ICUAW is multifactorial and complex. Potential therapeutic approaches are the early and sufficient therapy of mulitorgan dysfunction, optimal control of glucose levels as well as early and intensive physiotherapy...
March 2016: Der Nervenarzt
Shauna Burkholder, Lee Burkholder, Matthew Prowse, Joe Watt, Ari Joffe
No abstract text is available yet for this article.
December 2015: Critical Care Medicine
Takamichi Kanbayashi, Masahiro Sonoo
Chronic inflammatory demyelinating polyneuropathy (CIDP) is characterized by an insidious onset showing progression over two months. However, up to 16% of CIDP patients may show acute presentation similar to Guillain-Barré syndrome (GBS). Such cases are termed acute-onset CIDP (A-CIDP). Distinguishing A-CIDP from GBS, especially the acute inflammatory demyelinating polyneuropathy (AIDP) subtype, is critical because therapeutic strategies and outcomes may differ between the two syndromes. Regarding clinical features, A-CIDP is less likely to have autonomic nervous system involvement, facial weakness, a preceding infectious illness, or the need for mechanical ventilation, in comparison with AIDP...
November 2015: Brain and Nerve, Shinkei Kenkyū No Shinpo
Humberto Gonzalez Marrero, Erik V Stålberg
INTRODUCTION: In severe acute quadriplegic myopathy in intensive care unit (ICU) patients, muscle fibers are electrically inexcitable; in critical illness polyneuropathy, the excitability remains normal. Conventional electrodiagnostic methods do not provide the means to adequately differentiate between them. In this study we aimed to further optimize the methodology for the study of critically ill ICU patients and to create a reference database in healthy controls. METHODS: Different electrophysiologic protocols were tested to find sufficiently robust and reproducible techniques for clinical diagnostic applications...
April 2016: Muscle & Nerve
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
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