Critical illness neuromuscular weakness

Related Subjects: |Respiratory Failure |Non invasive ventilation (NIV) |Intubation and Mechanical Ventilation |Critical illness neuromuscular weaknesss |Haemodialysis |Dobutamine

The most common acquired causes of weakness in the critically ill patient in the intensive care unit are critical illness polyneuropathy and critical illness myopathy

About

• Delays recovery and adds to the morbidity

Aetiology

• Use of paralysing agents or steroids
• Polyneuropathy and myopathy

Causes of weakness in the ITU

Clinical

• Prolonged ITU admission: Severe sepsis or respiratory failure or brain injury
• Slow to wean off ventilator weak respiratory muscles
• Generalised Muscle weakness, reduced reflexes
• Initially flaccid quadriplegia then spastic
• Symmetrical facial weakness may be seen

Differentials

• Guillain Barre syndrome (Axonal or demyelinating)
• Rhabdomyolysis CK > 10,000

Investigations

• FBC, U&E, LFTs, B12, folate, CK
• EMG and NCT often shows axonal neuropathy
• LP if Guillan Barre considered
• Magnetic resonance imaging (MRI) of the brain and spine may need to be ordered in selected cases when there is a suspicion of upper motor neuron involvement

Management

• Supportive or focused on a found cause
• Physiotherapy and rehabilitation period
• Good nutrition and care

References