Critical illness polyneuropathy and myopathy in patients with acute respiratory distress syndrome.
OBJECTIVE
Critical illness polyneuropathy/myopathy (CIP/CIM) is frequently described in critically ill patients who survive severe sepsis. Clinically relevant paresis is major symptom of CIP/CIM. We aimed at determining risk factors and diagnostic value of electrophysiologic testing for CIP/CIM in patients with acute respiratory distress syndrome (ARDS).


METHODS
Single-center, retrospective analysis, using charts.


METHODS
University medical center.


METHODS
Fifty consecutive ARDS patients in our intensive care unit.


METHODS
Patient characteristics and clinical course were analyzed. All patients received early electrophysiologic testing. CIP/CIM was diagnosed by the presence of clinical relevant paresis.


RESULTS
Clinically relevant paresis was confirmed in 27 ARDS patients (60%), whereas in 18 patients no paresis was determined (controls); five patients died before clinical assessment of paresis was feasible. Patients with paresis were older, had more days on mechanical ventilation, and had increased intensive care unit length of stay compared with controls. Patients who developed paresis had elevated daily peak blood glucose levels during 28 days of intensive care unit treatment: 166 (134, 200) mg/dL in CIP/CIM patients vs. 144 (132, 161) mg/dL in controls (median, quartiles). Twenty-five of 27 patients with paresis revealed reduced motor unit potentials, fibrillation potentials, or positive sharp waves on early electrophysiologic testing indicating CIP/CIM, whereas 16 of 18 control patients did not.


CONCLUSIONS
In ARDS patients, paresis is a frequent complication causing prolonged mechanical ventilation and intensive care unit length of stay. An association between hyperglycemia and CIP/CIM has been found. However, since this is a retrospective survey, a causal relation is not clearly supported. In this study, the use of early electrophysiologic testing in ARDS patients was a valuable diagnostic tool for detecting CIP/CIM.
Bercker
Sven
S
Department of Anesthesiology and Intensive Care Medicine, Charité, Campus Virchow-Klinikum, University Medical Center, Berlin, Germany.
Weber-Carstens
Steffen
S
Deja
Maria
M
Grimm
Claudia
C
Wolf
Steffen
S
Behse
Friedrich
F
Busch
Thilo
T
Falke
Konrad J
KJ
Kaisers
Udo
U
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D015897:Comorbidity; D004594:Electrophysiology / Q000379:methods; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009135:Muscular Diseases / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D010291:Paresis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D011115:Polyneuropathies / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology
D001786:Blood Glucose; D006854:Hydrocortisone