Diagnosis and management of critical illness: myopathy or neuropathy
81 slide(s) – 00:34:35– English –2010-09-27
Critically ill patients may suffer from acute myopathy and neuropathy acquired during their intensive care unit (ICU) stay. These neuromuscular complications are indicated as critical illness myopathy (CIM) and critical illness polyneuropathy (CIP). CIP is an axonal polyneuropathy and in its classic presentation is a sensory-motor axonal polyneuropathy. CIM is a primary muscle disorder that is frequently, if not invariably, associated to CIP. This is why terms such as CRIMYNE (critical illness myopathy and/or neuropathy), CINMA (critical illness neuromuscular abnormalities) and CINM (critical illness neuromyopathy) have been proposed, encompassing both neuropathic and myopathic disease components. Although the exact incidence of CRIMYNE is unknown due to wide variation in diagnostic criteria, timing of evaluation and patients case mix; a recent systematic review reported a 46%incidence of CRIMYNE among patients with sepsis, multiple organ failure (MOF) or prolonged mechanical ventilation. Incidence is lower (30.4%) in critically ill patients with no evidence of MOF at ICU admission. CRIMYNE carries high morbidity and mortality rates. Weakness of limb and respiratory muscles is the major finding, which can be severe enough to cause tetraparesis or tetraplegia, and prolonged ventilator dependence. As such, the associated care is a major determinant of healthcare costs. In addition, the duration of muscle weakness after discharge from the acute-care hospital can be weeks, months or even years. Patients with CIM seem to have a more rapid and complete recovery than patients with CIP; therefore, electrophysiological diagnosis remains an essential part of the diagnostic work-up in these patients.