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    Evaluation of Critical Illness Polyneuropathy/Myopathy in Pediatric Intensive Care Unit
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    Research Article
    VOLUME: 7 ISSUE: 3
    P: 108-111
    December 2020

    Evaluation of Critical Illness Polyneuropathy/Myopathy in Pediatric Intensive Care Unit

    J Pediatr Emerg Intensive Care Med 2020;7(3):108-111
    DOI: 10.4274/cayd.galenos.2020.98598
    Didar Arslan 1
    Rıza Dinçer Yıldızdaş 1
    Özden Özgür Horoz 1
    Nagehan Aslan 1
    Yasemin Çoban 1
    Şakir Altunbaşak 2
    Mehmet Balal 3
    Zeliha Haytoğlu 4
    1. Çukurova Üniversitesi Tıp Fakültesi, Çocuk Yoğun Bakım Anabilim Dalı, Adana, Türkiye
    2. Çukurova Üniversitesi Tıp Fakültesi, Çocuk Nöroloji Anabilim Dalı, Adana, Türkiye
    3. Çukurova Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, Adana, Türkiye
    4. Çukurova Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Adana, Türkiye
    No information available.
    No information available
    Received Date: 16.10.2019
    Accepted Date: 10.06.2020
    Publish Date: 18.12.2020
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    ABSTRACT

    Introduction:

    The aim of this study was to determine the frequency of patients with critical illness polyneuropathy/myopathy followed by mechanical ventilator in the intensive care unit, and to determine the risk factors associated with this condition and discuss them with the literature.

    Methods:

    This study was performed retrospectively (August 2012 to August 2017), at a tertiary university hospital in Turkey. A total of 31 patients who were on mechanical ventilation and diagnosed with polyneuropathy/myopathy by electroneuromyography (ENMG) during pediatric intensive care unit follow-up were included in the study. Data were collected from patient files and computer system. Demographic characteristics of the patients, causes of hospitalization, underlying disease, length of the pediatric intensive care unit and hospital stay, length of mechanical ventilation, and treatment modalities were recorded. Patients without respiratory support and patients on mechanical ventilation without ENMG procedures were excluded.

    Results:

    A total of 31 patients were included in the study. Myopathy was present in 5/31 (16.1%) and polyneuropathy in 26/31 (83.9%) patients. Respiratory distress/failure was the most common cause of respiratory support (n=10, 32.3%) and the second most common cause was post cardiac surgery (n=9, 29%). The diagnosis of 18 (58%) patients were sepsis and 2 (6.4%) patients had multiple organ failure. The mean duration of mechanical ventilation was 27.4±14.1 days, length of pediatric intensive care unit stay was 41.5±24 days, length of hospital stay was 57.5±27.5 days. Mortality was observed in 5 (16.1%) of 31 patients.

    Conclusion:

    Critical illness polyneuropathy and myopathy in intensive care practice is a condition with increasing frequency and importance. Increased attention to this matter allows to take the necessary preventions, early recognition and to make the appropriate approach.

    Keywords: Critical illness myopathy, critical illness polyneuropathy, intensive care unit acquired weakness, pediatric intensive care

    References

    1
    Lacomis D. Neuromuscular disorders in critically ill patients: review and update. J Clin Neuromuscul Dis. 2011;12:197-218.
    2
    Zochodne DW, Bolton CF, Wells GA, Gilbert JJ, Hahn AF, et al. Critical illness polyneuropathy: A complication of sepsis and multiple organ failure. Brain. 1987;110:819-42.
    3
    Zink W, Kollmar R, Schwab S. Critical illness polyneuropathy and myopathy in the intensive care unit. Nat Rev Neurol. 2009;5:372-9.
    4
    Wilmshurst PT, Treacher DF, Lantos PL, Wiles CM. Critical illness poly-neuropathy following severe hyperpyrexia. QJM. 1995;88:351-5.
    5
    Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G. Interventions for preventing critical illness polyneuropathy and critical illness myopathy. Cochrane Database Syst Rev. 2009;21:CD006832.
    6
    Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G. Clinical review: Critical illness polyneuropathy and myopathy. Crit Care. 2008;12:238.
    7
    De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288:2859-67.
    8
    Khan J, Harrison TB, Rich MM, Moss M. Early development of critical illness myopathy and neuropathy in patients with severe sepsis. Neurology. 2006;67:1421-5.
    9
    Latronico N, Fenzi F, Recupero D, Candiani A, Guarneri B, et al. Critical illness myopathy and neuropathy. Lancet. 1996;347:1579-82.
    10
    Rich MM, Bird SJ, Raps EC, McCluskey LF, Teener JW. Direct muscle stimulation in acute quadriplegic myopathy. Muscle Nerve. 1997;20:665-73.
    11
    Lacomis D, Giuliani MJ, Van Cott A, Kramer DJ. Acute myopathy of intensive care: clinical, electromyographic, and pathological aspects. Ann Neurol. 1996;40:645-54.
    12
    Zhou C, Wu Ş, Ni F, Ji W, Wu J, et al. Critical illness polyneuropathy and myopathy: a systematic review. Neural Regen Res. 2014;9:101-10.
    13
    Banwell BL, Mildner RJ, Hassall AC, Becker LE, Vaisar J, et al. Muscle weakness in critically ill children. Neurology. 2003;61:1779-82.
    14
    Field-Ridley A, Dharmar M, Steinhorn D, McDonald C, Marcin JP. ICU-acquired weakness is associated with differences in clinical outcomes in critically ıll children. Pediatr Crit Care Med. 2016;17:53-7.
    15
    Thiele RI, Jakob H, Hund E, Genzwuerker H, Herold U, et al. Critical illness polyneuropathy: a new iatrogenically induced syndrome after cardiac surgery? Eur J Cardiothorac Surg. 1997;12:826-35.
    16
    Price DR, Mikkelsen ME, Craig A. Umscheid, Ehrin J. Armstrong. Neuromuscular Blocking Agents and Neuromuscular Dysfunction Acquired in Critical Illness: A Systematic Review and Meta-Analysis. Crit Care Med. 2016;44:2070-78.
    17
    Polsonetti BW, Joy SD, Laos LF. Steroid-ınduced myopathy in the ICU. Ann Pharmacother. 2002;36:1741-4.
    18
    Knox AJ, Mascie-Taylor BH, Muers MF. Acute hydrocortisone myopathy in acute severe asthma. Thorax. 1986;41:411-2.
    19
    Larsson L, Li X, Edstrom L, Eriksson LI, Zackrisson H, et al. Acute quadriplegia and loss of muscle myosin in patients treated with nondepolarizing neuromuscular blocking agents and corticosteroids: mechanisms at the cellular and molecular levels. Crit Care Med. 2000;28:34-45.
    20
    Fischer JR, Baer RK. Acute myopathy assocıated wıth combıned use of cortıcosteroids and neuromuscular blocking agents. Ann Pharmacother. 1996;30:1437-45.
    21
    Garnacho-Montero J, Madrazo-Osuna J, García-Garmendia JL, Ortiz-Leyba C, Jiménez-Jiménez FJ, et al. Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med. 2001;27:1288-96.
    22
    Grill MF, Maganti RK. Neurotoxic effects associated with antibiotic use: management considerations. Br J Clin Pharmacol. 2011;72:381-93.
    23
    Witt NJ, Zochodne DW, Bolton CF, Grand'Maison F, Wells G, et al. Peripheral nerve function in sepsis and multiple organ failure. Chest. 1991;99:176-84.
    24
    Van den Berghe G, Schoonheydt K, Becx P, Bruyninckx F, Wouters PJ. Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology. 2005;64:1348-53.
    25
    Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008;300:933-44.
    26
    Bilan N, Sadegvand S, Ranjbar S. Therapeutic effect of ınsulin in reducing critical ıllness; polyneuropathy and myopathy in the pediatric ıntensive care unit. Iran J Child Neurol. 2012;6:9-13.
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