Neuromuscular dysfunction acquired in critical illness: a systematic review.
OBJECTIVE
To determine the prevalence, risk factors, and outcomes of critical illness neuromuscular abnormalities (CINMA).


METHODS
Systematic review.


METHODS
MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched for reports on adult ICU patients who were evaluated for CINMA clinically and electrophysiologically. Studies were included if they contained sufficient data to quantify the association between CINMA and relevant exposures and/or outcome variables.


RESULTS
CINMA was diagnosed in 655 of 1421 [46% (95% confidence interval 43-49%)] adult ICU patients enrolled in 24 studies, all with inclusion criteria of sepsis, multi-organ failure, or prolonged mechanical ventilation. Diagnostic criteria for CINMA were not uniform, and few reports unequivocally differentiated between polyneuropathy, myopathy, and mixed types of CINMA. The risk of CINMA was associated with hyperglycemia (and inversely associated with tight glycemic control), the systemic inflammatory response syndrome, sepsis, multiple organ dysfunction, renal replacement therapy, and catecholamine administration. Across studies, there was no consistent relationship between CINMA and patient age, gender, severity of illness, or use of glucocorticoids, neuromuscular blockers, aminoglycosides, or midazolam. Unadjusted mortality was not increased in the majority of patients with CINMA, but mechanical ventilation and ICU and hospital stay were prolonged.


CONCLUSIONS
The risk of CINMA is nearly 50% in ICU patients with sepsis, multi-organ failure, or protracted mechanical ventilation. The association of CINMA with frequently cited CINMA risk factors (glucocorticoids, neuromuscular blockers) and with short-term survival is uncertain. Available data indicate glycemic control as a potential strategy to decrease CINMA risk.
Stevens
Robert D
RD
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe St, Meyer 8-140, Baltimore, MD 21287, USA. rstevens@jhmi.edu
Dowdy
David W
DW
Michaels
Robert K
RK
Mendez-Tellez
Pedro A
PA
Pronovost
Peter J
PJ
Needham
Dale M
DM
D003422:Critical Care; D016638:Critical Illness; D006801:Humans; D009468:Neuromuscular Diseases / Q000453:epidemiology / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D014481:United States / Q000453:epidemiology