Neuromuscular paralysis in the intensive care unit.
OBJECTIVE
To determine the features, causes, risk factors and outcome of acquired neuromuscular paralysis in critically ill patients.


METHODS
Retrospective review of all confirmed cases of acquired polyneuropathy and myopathy examined by our Neurology service in the Intensive Care Unit (ICU), at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia over a period of 5 years. All patients had comprehensive electrophysiological studies and one third had muscle and nerve biopsies.


RESULTS
Thirty cases were included, 8 cases of polyneuropathy, 15 cases of myopathy and 7 cases of mixed neuropathy and myopathy. Absent deep tendon reflexes and absent sensory potential on nerve conduction studies were significantly suggestive of neuropathy. The level of creatine phosphokinase was not of great diagnostic value. Most polyneuropathy and myopathy cases had passed through a stormy ICU course with sepsis and multiorgan failure. The use of high doses of steroids was more associated with myopathy. Seven patients died in ICU, the others were discharged to the wards after a mean ventilation period of 40 days. One patient became chronic ventilator dependent.


CONCLUSIONS
From this series and available literature, it seems that symptomatic myopathy is more frequent than polyneuropathy and some risk factors are common for both (sepsis and multiorgan failure) while the use of steroids is more associated with ICU myopathy. Treating sepsis and stopping corticosteroids results in the improvement of most of the cases.
Al-Jumah
Mohammed A
MA
Neurology Section, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. jumahm@ngha.med.sa
Awada
Adnan A
AA
Al-Ayafi
Hassan A
HA
Kojan
Suleiman W
SW
Al-Shirawi
Nahed
N
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications; D009135:Muscular Diseases / Q000209:etiology*; D011115:Polyneuropathies / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications
D000305:Adrenal Cortex Hormones