Is critical illness neuromyopathy and duration of mechanical ventilation decreased by strict glucose control?
Strict glycemic control (SGC) is reported to have a beneficial effect on critical illness polyneuropathy/myopathy (CINM) and the duration of mechanical ventilation. The methodology used to diagnose CINM differs substantially in studies on this topic. This may influence the reported treatment effect. We reviewed literature on the effect of SGC on CINM and duration of ventilation by conducting a OVID Medline systematic electronic search of literature describing effects of SGC on occurrence of CINM and the effect of SGC on the duration of mechanical ventilation. A beneficial effect of SGC on CINM, diagnosed by needle myography, was reported in three studies. One of these studies showed that the incidence of weakness or failure to wean did not decrease by SGC, as the number of electrophysiological studies (EMG) ordered for these problems remained the same. Another study reported no improvement of muscle strength due to SGC. SGC reduced the duration of mechanical ventilation in three studies while six other studies did not report this beneficial effect. SGC seems to have a beneficial effect on CINM, but the reported risk reduction is likely to be an overestimation of the treatment effect due to the diagnostic methods used. Duration of mechanical ventilation may not be a reliable surrogate marker for CINM and a beneficial effect of SGC on this parameter has not been proven. We propose to use the recently developed diagnostic criteria for ICU-acquired weakness and critical illness neuromyopathy in future studies.
Department of Intensive Care Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. L.Wieske@amc.uva.nl
Luuk
L
Wieske
Robin E
RE
Harmsen
Marcus J
MJ
Schultz
Janneke
J
Horn
D001786:Blood Glucose / Q000378:metabolism*; D004576:Electromyography / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay; D053580:Muscle Strength / Q000187:drug effects; D009460:Neurologic Examination / Q000187:drug effects; D011115:Polyneuropathies / Q000097:blood* / Q000628:therapy*; D012121:Respiration, Artificial; D012307:Risk Factors; D015300:Ventilator Weaning
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
Crit Care. 2010;14(3):223
20550725
N Engl J Med. 2006 Feb 2;354(5):449-61
16452557
Intensive Care Med. 2010 Jan;36(1):66-74
19760204
Crit Care Med. 2009 Sep;37(9):2632-7
19623045
Neurology. 2005 Apr 26;64(8):1348-53
15851721
Crit Care Med. 2009 Oct;37(10 Suppl):S316-20
20046116
Crit Care. 2005;9(6):R790-7
16356228
Crit Care Med. 2008 Dec;36(12):3190-7
18936702
N Engl J Med. 2008 Jan 10;358(2):125-39
18184958
Control Clin Trials. 1996 Feb;17(1):1-12
8721797
Anesthesiology. 2009 Mar;110(3):611-9
19237874
Am J Respir Crit Care Med. 2008 Aug 1;178(3):261-8
18511703
Am J Respir Crit Care Med. 2007 Mar 1;175(5):480-9
17138955
N Engl J Med. 2001 Nov 8;345(19):1359-67
11794168
Intensive Care Med. 2009 Oct;35(10):1738-48
19636533
JAMA. 2010 Jan 27;303(4):341-8
20103758
Crit Care Med. 2009 Oct;37(10 Suppl):S299-308
20046114
Crit Care Med. 2009 Oct;37(10 Suppl):S391-7
20046125
N Engl J Med. 2009 Mar 26;360(13):1283-97
19318384
Pol Arch Med Wewn. 2009 Jul-Aug;119(7-8):439-46
19776683
Crit Care. 2009;13(1):R5
19166623