Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis

Summary Critical illness polyneuropathy (CIP) and myopathy (CIM) are complications of critical illness that present with muscle weakness and failure to wean from the ventilator. In addition to prolonging mechanical ventilation and hospitalisation, CIP and CIM increase hospital mortality in patients...

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Bibliographic Details
Published in:Lancet neurology 2011-10, Vol.10 (10), p.931-941
Main Authors: Latronico, Nicola, Prof, Bolton, Charles F, Prof
Format: Article
Language:English
Subjects:
Anesthesia
Atrophy
Biopsy
Channelopathy
Consciousness
Denervation
Electrophysiology
Energy
Excitability
Hospital Mortality
Hospitals
Humans
Hyperglycemia
Hypoxia
Illnesses
Intensive care
Intensive care units
Medical prognosis
Microvasculature
Mortality
Muscle strength
Muscle Weakness - etiology
Muscles
Muscular Diseases - complications
Muscular Diseases - diagnosis
Muscular Diseases - mortality
Muscular Diseases - therapy
Myopathy
Myosin
Necrosis
Nerves
Neurodegeneration
Neurology
Paralysis
Paralysis - etiology
Patients
Polyneuropathies - complications
Polyneuropathies - diagnosis
Polyneuropathies - mortality
Polyneuropathies - therapy
Polyneuropathy
Recovery of function
Rehabilitation
Sepsis
Steroids
Ventilators
Weaning
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Summary:Summary Critical illness polyneuropathy (CIP) and myopathy (CIM) are complications of critical illness that present with muscle weakness and failure to wean from the ventilator. In addition to prolonging mechanical ventilation and hospitalisation, CIP and CIM increase hospital mortality in patients who are critically ill and cause chronic disability in survivors of critical illness. Structural changes associated with CIP and CIM include axonal nerve degeneration, muscle myosin loss, and muscle necrosis. Functional changes can cause electrical inexcitability of nerves and muscles with reversible muscle weakness. Microvascular changes and cytopathic hypoxia might disrupt energy supply and use. An acquired sodium channelopathy causing reduced muscle membrane and nerve excitability is a possible unifying mechanism underlying CIP and CIM. The diagnosis of CIP, CIM, or combined CIP and CIM relies on clinical, electrophysiological, and muscle biopsy investigations. Control of hyperglycaemia might reduce the severity of these complications of critical illness, and early rehabilitation in the intensive care unit might improve the functional recovery and independence of patients.
ISSN:1474-4422
1474-4465
DOI:10.1016/S1474-4422(11)70178-8