Critical illness polyneuropathy: a new iatrogenically induced syndrome after cardiac surgery?
OBJECTIVE
Critical illness polyneuropathy (CIP) is a newly described severe complication after open heart surgery leading to tetraplegia for weeks to months. The purpose of the study was to gather further information on critical illness polyneuropathy developing in patients after cardiac surgery and to evaluate the hypothetical risk factors possibly related to the onset of this neurological disorder.


METHODS
From July 1994 to October 1995, 7 out of 1511 patients undergoing open heart surgery developed critical illness polyneuropathy, which was diagnosed on the basis of electromyographic and nerve conduction features. The only common clinical finding was an intensive care unit (ICU) stay beyond seven days, therefore a similar group of 37 patients staying longer than seven days in the intensive care unit during the same period of time was evaluated and retrospectively compared to the 7 patients developing critical illness polyneuropathy. Univariate analysis of several traits was performed to evaluate possible risk factors.


RESULTS
4 Out of 7 patients in the CIP group died, all due to multiple organ failure, in contrast to 3/37 patients in the control group, again due to multiple organ failure. Patients developing CIP were staying significantly longer in the ICU (62+/-3 versus 14+/-8 days, P < 0.01) and had a significantly longer time on ventilator support (50+/-28 versus 7+/-13 days, P < 0.01) The incidence of sepsis was significantly higher in the CIP group than in the control group (85.7 versus 10.8%, P < 0.01). Compared to the control group the proportion of patients receiving corticosteroids (100 versus 10.8%, P < 0.01) and increased dosages of epinephrine and norepinephrine was higher in the CIP group (85.7 versus 35.1%, P < 0.05). Furthermore, the proportion of patients requiring chronic venovenous hemodiafiltration was significantly elevated in the CIP group (85.7 versus 5.4%, P < 0.01).


CONCLUSIONS
CIP, despite it's benign nature due to it's spontaneous remission in patients who survive, is a disturbing complication following cardiac surgery which is associated with high mortality, a prolonged stay in the ICU, as well as an extended time on ventilator support. Interventions like chronic hemodiafiltration, the application of corticosteroids and the administration of high doses of catecholamines are more frequent in patients with CIP. Whether this indicates a causal relationship remains to be elucidated.
Thiele
R I
RI
Department of Cardiac Surgery, Ruprecht-Karls-University, Heidelberg, Germany.
Jakob
H
H
Hund
E
E
Genzwuerker
H
H
Herold
U
U
Schweiger
P
P
Hagl
S
S
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016638:Critical Illness; D004576:Electromyography; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D017583:Hemodiafiltration; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D009422:Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D009638:Norepinephrine / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome
D000316:Adrenergic alpha-Agonists; D009638:Norepinephrine; D004837:Epinephrine