Metabolic aspects of critical illness polyneuromyopathy.
Critically ill patients frequently develop muscle weakness due to critical illness-related acute neuropathy and/or myopathy. This is a frequent disorder, with important short-term consequences that include difficulties in weaning from mechanical ventilation, associated prolonged intensive care unit and hospital stay, and increased mortality rates. In addition, many patients continue to suffer from decreased exercise capacity and quality of life for months to years after the acute event. Many different mechanisms seem to be involved in the development of this process. In this review, we will focus on the metabolic aspects of critical illness-related acute neuropathy and/or myopathy and, more specifically, on our clinical experience with achieving strict glycemic control using insulin. Our group has performed two randomized controlled trials in surgical and medical critically ill patients and studied the occurrence of critical illness-related acute neuropathy and/or myopathy and delayed weaning, one of its most important complications. Potential underlying mechanisms derived from experimental studies and from the analysis of biopsy samples harvested from critically ill patients or patients suffering from other catabolic states are discussed.
Hermans
Greet
G
Department of General Internal Medicine, Medical Intensive Care Unit, Katholieke Universiteit Leuven, Leuven, Belgium.
Vanhorebeek
Ilse
I
Derde
Sarah
S
Van den Berghe
Greet
G
D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007902:Length of Stay; D015201:Meta-Analysis as Topic; D009135:Muscular Diseases / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism* / Q000473:pathology; D009468:Neuromuscular Diseases / Q000209:etiology / Q000378:metabolism; D011115:Polyneuropathies / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000009:adverse effects; D012132:Respiratory Muscles / Q000187:drug effects; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin