[Pathophysiology of neuromuscular impairments in the critically ill patient].
OBJECTIVE
to analyze the causes and manifestations of muscle weakness that critically ill patients develop during their staying at the ICU, and literature review.


METHODS
in the early 1980s, a mixed axonal polyneuropathy was described in septic critically ill patients, which clinically manifested by muscle weakness of variable severity, leading to quadriplegia and/or ventilator dependency in its most severe presentation. Almost at the same time, an acute intensive care myopathy was described in asthmatic patients admitted to the ICU for asthma exacerbation. Later on, this myopathy was also observed in transplanted, septic, or burnt patients. Several authors consider acute intensive care myopathy as the main cause of muscle weakness in the ICU.


CONCLUSIONS
in this article, we describe the clinical presentation, etiopathogenesis, diagnosis, and treatment of polyneuropathy of the critically ill patient and of acute intensive care myopathy. Both clinical pictures may be differentiated, with neurophysiological studies and eventually muscle biopsy being of great help. Although some authors rather include these conditions under the name of polyneuromyopathy, we propose the general denomination of Acute Neuromuscular Syndrome of the Critically Ill Patient, a more descriptive term no presupposing a single mechanism or etiology.
García de Lorenzo
A
A
Cátedra UAM-Abbott de Medicina Crítica, Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid. agdl@telefonica.net
Vilas
E
E
Rodríguez Montes
J A
JA
D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D018908:Muscle Weakness / Q000503:physiopathology*; D009135:Muscular Diseases / Q000503:physiopathology*; D011115:Polyneuropathies / Q000503:physiopathology*; D013577:Syndrome