Critical illness polyneuropathy, myopathy or polyneuromyopathy: future directions
| Authors | |
|---|---|
| Year of publication | 2005 |
| Type | Article in Periodical |
| Magazine / Source | International Journal of Intensive Care |
| MU Faculty or unit | |
| Citation | |
| Field | Neurology, neurosurgery, neurosciences |
| Keywords | critical illness; polyneuropathy; myopathy |
| Description | Two main clinical, pathological and electrophysiological types of acquired neuromuscular involvement in critically ill patients have been described in the past two decades: critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). There, however, still exist many controversies and unresolved questions concerning definition, ter-minology, diagnosis and differentiation of these two entities. The differentiation between CIP and CIM is based on the typical clinical, electrophysiological and histopathological signs of acute axonal sensory-motor polyneuropathy and several pathological subtypes of myopathy and on assumption that most cases can be categorised as one type or the other. There is, however, increasing evidence that the final diagnosis - CIP, CIM or both - is critically dependent on the method used, and that myopathy may coexist with neuropathy. The published etiological studies are limited by small numbers; however, inconsistent eligibility criteria and inconsistent case definitions prevent combining the results by metaanalysis. Improved epidemiological studies on the incidence of acquired neuromuscular involvement and on all potential risk factors with complete evaluation of all ICU patients at risk are needed. Studies utilising clinical and electrophysiological techniques should avoid strict categorisation of cases into CIP or CIM, but would preferably use description of main electrophysiological syndromes. Muscle biopsy as an invasive technique is not a suitable diagnostic tool for large epidemiological studies. Nevertheless, it would be helpful to organise large multicenter study utilising biopsy and differentiating all histopathological types of CIM to solve the epidemiological and etiological dilemmas. Acquired neuromuscular weakness in critically ill patients should be looked at as dysfunction or failure of another (neuromuscular) system that could be detected early dur-ing critical illness. Measures of neuromuscular function should be included as an outcome measure in all interventional ICU studies. |
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