Combination of histopathological and electromyographic patterns can help to evaluate functional outcome of critical ill patients with neuromuscular weakness syndromes.
BACKGROUND
The aim of the study was to describe patterns of neuromuscular weakness using a combination of electromyography and histology, and to evaluate functional outcome in patients following complicated cardiovascular surgery.


METHODS
Fifteen adults requiring long-term mechanical ventilation (>15 days) following cardiovascular surgery associated with postoperative complications were prospectively included. Electrophysiological and histological analyses (muscle and nerve) were performed when failure to wean from mechanical ventilation associated with peripheral neuromuscular weakness was noticed. Functional disability was evaluated 12 months after surgery.


RESULTS
Six patients had a predominantly axonal neuropathy, six presented with myopathy, and three patients had a combination of axonal neuropathy and myopathy. All of them presented with acute tetraparesis and failure to wean from mechanical ventilation. All of the study patients who received corticosteroids exhibited a myopathic pattern (with or without axonopathic changes) but never an axonopathic pattern only. Only two of the eight survivors at 12 months were not ambulatory. These two patients had no detectable compound muscle action potential on electrophysiological examination.


CONCLUSIONS
The combination of electromyographic evaluation and neuromuscular histological abnormalities could help to identify the type and severity of neuromuscular weakness, in turn helping to evaluate the patient's potential functional prognosis.
Kerbaul
François
F
Département d'Anesthésie-Réanimation Adulte, Groupe Hospitalier de La Timone, Marseille, France. fkerbaul@yahoo.fr
Brousse
Muriel
M
Collart
Frédéric
F
Pellissier
Jean-François
JF
Planche
Denis
D
Fernandez
Carla
C
Gouin
François
F
Guidon
Catherine
C
D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000534:rehabilitation*; D016638:Critical Illness; D004576:Electromyography; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D009468:Neuromuscular Diseases / Q000175:diagnosis* / Q000503:physiopathology; D010291:Paresis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013577:Syndrome; D017211:Treatment Failure; D015300:Ventilator Weaning