Early development of critical illness myopathy and neuropathy in patients with severe sepsis.
OBJECTIVE
To characterize the prevalence, time of onset, and cause of neuromuscular dysfunction in patients with severe sepsis.


METHODS
We conducted a prospective cohort study in which participants with severe sepsis underwent weekly neurologic examinations and nerve conduction studies (NCSs) within 72 hours of developing severe sepsis until intensive care unit (ICU) discharge. Electromyography was preformed if clinical weakness developed or if there was a significant reduction in nerve conduction response amplitudes.


RESULTS
Abnormal NCS were present upon enrollment in 63% of patients (31/48). The presence of abnormal baseline NCS was predictive of hospital mortality (55% vs 0% for patients with normal baseline NCS; p < 0.001). Development of acquired neuromuscular dysfunction could be predicted by NCS done on day 7. Twenty patients remained in the ICU long enough to have serial NCSs; 50% of these patients developed acquired neuromuscular dysfunction. Most patients with acquired neuromuscular dysfunction had electrophysiologic evidence of both critical illness myopathy and critical illness neuropathy.


CONCLUSIONS
Changes in nerve conduction studies occur in the majority of patients early in the course of severe sepsis and predict the development of acquired neuromuscular dysfunction and mortality in intensive care unit patients. Most patients with acquired neuromuscular dysfunction after sepsis have both critical illness myopathy and critical illness neuropathy.
Khan
Jaffar
J
Department of Neurology, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA. jkhan@emory.edu
Harrison
Taylor B
TB
Rich
Mark M
MM
Moss
Marc
M
D000328:Adult; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D009468:Neuromuscular Diseases / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D012720:Severity of Illness Index; D013997:Time Factors