Critical illness neuromuscular abnormalities.
CINMAs occur commonly in acutely critically ill inflamed patients, and can prolong respiratory failure, lead to ventilator dependency, and contribute to the development of chronic critical illness. The etiology of NMDs are diverse and overlap, and distinguishing different disease entities by clinical exam and electrophysiologic studies can be difficult. CIP, which has been the most widely studied CINMA, represents the peripheral nervous system manifestation of the MODS. Patients with CIP, particularly those with severely reduced nerve function, have a prolonged rehabilitation and a high mortality rate. Although there are no definitive treatments, diagnosing a CINMA may provide helpful prognostic information. Future preventative measures may include immunoglobulin, nerve growth factors, or strict glycemic control, although in the CCI phase general supportive care is given, including prevention of iatrogenic complications, nutritional support, psychosocial support, and physical therapy. The early recognition of CINMAs and prevention of associated complications are important to enabling CCI patients with CINMAs to recover and return home with an acceptable functional level and quality of life.
Lorin
Scott
S
Division of Pulmonary and Critical Care Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA. Scott.Lorin@MountSinai.org
Nierman
David M
DM
D003937:Diagnosis, Differential; D006801:Humans; D020511:Neuromuscular Junction Diseases / Q000139:chemically induced; D010791:Phrenic Nerve / Q000293:injuries; D011115:Polyneuropathies / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D012121:Respiration, Artificial; D018746:Systemic Inflammatory Response Syndrome; D015300:Ventilator Weaning