Ann Clin Neurophysiol.  2020 Oct;22(2):61-66. 10.14253/acn.2020.22.2.61.

Critical illness neuromyopathy

• Park SH
• Jeong YJ
• Kim NH

• KMID: 2511080
• DOI: http://doi.org/10.14253/acn.2020.22.2.61

Abstract

Critical illness neuromyopathy (CINM) is a common but frequently underdiagnosed condition in critically ill patients that contributes to ventilator weaning failure and limb weakness in intensive care unit (ICU). CINM is subdivided into critical illness polyneuropathy and critical illness myopathy, and the occurrence of these conditions in the ICU is associated with multiple organ failure due to sepsis or certain medications. CINM survivors might have persistent functional disabilities and a poor quality of life. This situation demonstrates the need for efforts to minimize or prevent CINM in critically ill patients. This article provides a current overview of CINM and the associated clinical strategies.

Keyword

Intensive-care unit; Critical illness; Polyneuropathy; Myopathy; Ventilator weaning

Figure

• 

  Fig. 1. Treatment of CINM.

Reference

1. Bolton CF. Neuromuscular manifestations of critical illness. Muscle Nerve. 2005; 32:140–163.

2. Lacomis D, Petrella JT, Giuliani MJ. Causes of neuromuscular weakness in the intensive care unit: a study of ninety-two patients. Muscle Nerve. 1998; 21:610–617.

3. Hund E. Neurological complications of sepsis: critical illness polyneuropathy and myopathy. J Neurol. 2001; 248:929–934.

4. De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002; 288:2859–2867.

5. Dhand UK. Clinical approach to the weak patient in the intensive care unit. Respir Care. 2006; 51:1024–1041.

6. Olsen CW. Lesions of peripheral nerves developing during coma. J Am Med Assoc. 1956; 160:39–41.

7. Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ. Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry. 1984; 47:1223–1231.

8. MacFarlane IA, Rosenthal FD. Severe myopathy after status asthmaticus. Lancet. 1977; 2:615.

9. Lacomis D, Zochodne DW, Bird SJ. Critical illness myopathy. Muscle Nerve. 2000; 23:1785–1788.

10. Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011; 10:931–941.

11. Visser LH. Critical illness polyneuropathy and myopathy: clinical features, risk factors and prognosis. Eur J Neurol. 2006; 13:1203–1212.

12. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014; 371:287–288.

13. Jolley SE, Bunnell AE, Hough CL. ICU-acquired weakness. Chest. 2016; 150:1129–1140.

14. Witteveen E, Wieske L, Verhamme C, Schultz MJ, van Schaik IN, Horn J. Muscle and nerve inflammation in intensive care unit-acquired weakness: a systematic translational review. J Neurol Sci. 2014; 345:15–25.

15. Shepherd S, Batra A, Lerner DP. Review of critical illness myopathy and neuropathy. Neurohospitalist. 2017; 7:41–48.

16. De Jonghe B, Lacherade JC, Durand MC, Sharshar T. Critical illness neuromuscular syndromes. Neurol Clin. 2008; 26:507–520.

17. Pandit L, Agrawal A. Neuromuscular disorders in critical illness. Clin Neurol Neurosurg. 2006; 108:621–627.

18. Stevens RD, Marshall SA, Cornblath DR, Hoke A, Needham DM, de Jonghe B, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med. 2009; 37:S299–S308.

19. Lorin S, Nierman DM. Critical illness neuromuscular abnormalities. Crit Care Clin. 2002; 18:553–568.

20. Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med. 2007; 33:1876–1891.

21. Apostolakis E, Papakonstantinou NA, Baikoussis NG, Papadopoulos G. Intensive care unit-related generalized neuromuscular weakness due to critical illness polyneuropathy/myopathy in critically ill patients. J Anesth. 2015; 29:112–121.

22. De Letter MA, van Doorn PA, Savelkoul HF, Laman JD, Schmitz PI, Op de Coul AA, et al. Critical illness polyneuropathy and myopathy (CIPNM): evidence for local immune activation by cytokine-expression in the muscle tissue. J Neuroimmunol. 2000; 106:206–213.

23. Garnacho-Montero J, Madrazo-Osuna J, García-Garmendia JL, Ortiz-Leyba C, Jiménez-Jiménez FJ, Barrero-Almodóvar A, et al. Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med. 2001; 27:1288–1296.

24. Zifko UA, Zipko HT, Bolton CF. Clinical and electrophysiological findings in critical illness polyneuropathy. J Neurol Sci. 1998; 159:186–193.

25. Tennilä A, Salmi T, Pettilä V, Roine RO, Varpula T, Takkunen O. Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med. 2000; 26:1360–1363.

26. Khan J, Harrison TB, Rich MM, Moss M. Early development of critical illness myopathy and neuropathy in patients with severe sepsis. Neurology. 2006; 67:1421–1425.

27. Johnson KL. Neuromuscular complications in the intensive care unit: critical illness polyneuromyopathy. AACN Adv Crit Care. 2007; 18:167–180.

28. Rich MM, Bird SJ, Raps EC, McCluskey LF, Teener JW. Direct muscle stimulation in acute quadriplegic myopathy. Muscle Nerve. 1997; 20:665–673.

29. Koch S, Spuler S, Deja M, Bierbrauer J, Dimroth A, Behse F, et al. Critical illness myopathy is frequent: accompanying neuropathyprotracts ICU discharge. J Neurol Neurosurg Psychiatry. 2011; 82:287–293.

30. Sitwell LD, Weinshenker BG, Monpetit V, Reid D. Complete ophthalmoplegia as a complication of acute corticosteroid-and pancuronium-associated myopathy. Neurology. 1991; 41:921–922.

31. 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; 64:1348–1353.

32. Zhou C, Wu L, Ni F, Ji W, Wu J, Zhang H. Critical illness polyneuropathy and myopathy: a systematic review. Neural Regen Res. 2014; 9:101–110.

33. Mohr M, Englisch L, Roth A, Burchardi H, Zielmann S. Effects of early treatment with immunoglobulin on critical illness polyneuropathy following multiple organ failure and gram-negative sepsis. Intensive Care Med. 1997; 23:1144–1149.

34. 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. 2014; (1):CD006832.

35. Berek K, Margreiter J, Willeit J, Berek A, Schmutzhard E, Mutz NJ. Polyneuropathies in critically ill patients: a prospective evaluation. Intensive Care Med. 1996; 22:849–855.

36. Leijten FS, Harinck-de Weerd JE, Poortvliet DC, de Weerd AW. The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation. JAMA. 1995; 274:1221–1225.

37. Campellone JV, Lacomis D, Kramer DJ, Van Cott AC, Giuliani MJ. Acute myopathy after liver transplantation. Neurology. 1998; 50:46–53.