Approach to neuromuscular disorders in the intensive care unit

摘要: Neuromuscular disorders increasingly are recognized as a complication in patients the intensive care unit (ICU) and represent common cause of prolonged ventilator dependency. The distinct syndromes critical illness myopathy, neuromuscular blockade, polyneuropathy (CIP) may arise consequence sepsis, multi-organ failure, exposure to various medications—notably, intravenous corticosteroids blocking agents—but pathophysiology these remains poorly understood. More than one syndrome occur simultaneously, distinctions be difficult particular patient, but specific diagnosis usually can established after careful clinical, electrodiagnostic, and, when necessary, histological evaluation. For example, asthmatics requiring treatment with agents develop an acute myopathy characterized by generalized weakness, preserved eye movements, elevated creatine kinase levels, myopathic motor units on electromyography (EMG). Muscle biopsy demonstrates distinctive features thick (myosin) filament loss ultrastructural studies. Conversely, those ICU course that is complicated episodes sepsis failure wean from ventilator, distal or flaccid limb areflexia probably have CIP. EMG reduced absent sensory potentials neurogenic units. Prolonged blockade most commonly occurs renal who received infusions blockers. There severe flaccid, areflexic paralysis normal sensation, facial ophthalmoparesis persists for days weeks blockers been discontinued. Repetitive nerve stimulation shows decrement compound muscle action potential cases, establishes disorder transmission. With recent epidemic West Nile virus infection, clinical several indistinguishable poliomyelitis has emerged. This article critically examines electrophysiological, pathological other context summarizes current understanding disorders.