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Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness.
Crit Care Med. 2003 Apr; 31(4):1012-6.CC

Abstract

OBJECTIVE

To establish the prevalence, clinical characteristics, and electrophysiologic features of residual neuromuscular dysfunction after prolonged critical illness.

DESIGN

Prospective follow-up study of survivors of prolonged critical illness.

SETTING

A university hospital and two district general hospitals in the UK.

PATIENTS

The study occurred for a period of 5 yrs. All patients during that time who were in the intensive care unit for >28 days were entered in the study.

MEASUREMENTS AND MAIN RESULTS

At follow-up, length of intensive care unit and hospital stay, duration of mechanical ventilation and admission Acute Physiology and Chronic Health Evaluation II score were recorded from the case notes. A clinical history was obtained, a Barthel Index disability score was calculated, and a full neurologic examination was performed. Nerve conduction studies, needle electromyography, single-fiber electromyography and thermal thresholds were performed. A total of 195 patients were identified. There were 86 survivors, of whom 47 could be contacted and 22 consented to be studied. The median time from intensive care unit discharge to follow-up was 43 months (range, 12-57 months). All gave a clear history of severe weakness and functional impairment after hospital discharge and, in all, recovery was prolonged. Motor or sensory deficits were present on clinical examination in 59% of the patients studied. Common peroneal nerve palsy was present in two patients. A total of 21 of 22 (95%) patients had electromyographic evidence of chronic partial denervation at follow-up, findings indicative of a preceding axonal neuropathy. The single-fiber electromyographic studies were also consistent with a preceding motor neuropathy.

CONCLUSION

Severe weakness requiring prolonged rehabilitation and abnormal clinical neurologic findings are extremely common in survivors of protracted critical illness. Neurophysiologic evidence of chronic partial denervation of muscle consistent with previous critical illness polyneuropathy is almost invariable and can be found up to 5 yrs after intensive care unit discharge in >90% of these long-stay patients. Evidence of myopathy is unusual. These findings have important implications for the management and rehabilitation of intensive care survivors.

Authors+Show Affiliations

Intensive Care Unit and Department of Neurophysiology, St. Bartholomew's Hospital, West Smithfield, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12682465

Citation

Fletcher, Simon N., et al. "Persistent Neuromuscular and Neurophysiologic Abnormalities in Long-term Survivors of Prolonged Critical Illness." Critical Care Medicine, vol. 31, no. 4, 2003, pp. 1012-6.
Fletcher SN, Kennedy DD, Ghosh IR, et al. Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med. 2003;31(4):1012-6.
Fletcher, S. N., Kennedy, D. D., Ghosh, I. R., Misra, V. P., Kiff, K., Coakley, J. H., & Hinds, C. J. (2003). Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Critical Care Medicine, 31(4), 1012-6.
Fletcher SN, et al. Persistent Neuromuscular and Neurophysiologic Abnormalities in Long-term Survivors of Prolonged Critical Illness. Crit Care Med. 2003;31(4):1012-6. PubMed PMID: 12682465.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. AU - Fletcher,Simon N, AU - Kennedy,Daniel D, AU - Ghosh,Indrajit R, AU - Misra,Vijay P, AU - Kiff,Kevin, AU - Coakley,John H, AU - Hinds,Charles J, PY - 2003/4/12/pubmed PY - 2003/5/2/medline PY - 2003/4/12/entrez SP - 1012 EP - 6 JF - Critical care medicine JO - Crit Care Med VL - 31 IS - 4 N2 - OBJECTIVE: To establish the prevalence, clinical characteristics, and electrophysiologic features of residual neuromuscular dysfunction after prolonged critical illness. DESIGN: Prospective follow-up study of survivors of prolonged critical illness. SETTING: A university hospital and two district general hospitals in the UK. PATIENTS: The study occurred for a period of 5 yrs. All patients during that time who were in the intensive care unit for >28 days were entered in the study. MEASUREMENTS AND MAIN RESULTS: At follow-up, length of intensive care unit and hospital stay, duration of mechanical ventilation and admission Acute Physiology and Chronic Health Evaluation II score were recorded from the case notes. A clinical history was obtained, a Barthel Index disability score was calculated, and a full neurologic examination was performed. Nerve conduction studies, needle electromyography, single-fiber electromyography and thermal thresholds were performed. A total of 195 patients were identified. There were 86 survivors, of whom 47 could be contacted and 22 consented to be studied. The median time from intensive care unit discharge to follow-up was 43 months (range, 12-57 months). All gave a clear history of severe weakness and functional impairment after hospital discharge and, in all, recovery was prolonged. Motor or sensory deficits were present on clinical examination in 59% of the patients studied. Common peroneal nerve palsy was present in two patients. A total of 21 of 22 (95%) patients had electromyographic evidence of chronic partial denervation at follow-up, findings indicative of a preceding axonal neuropathy. The single-fiber electromyographic studies were also consistent with a preceding motor neuropathy. CONCLUSION: Severe weakness requiring prolonged rehabilitation and abnormal clinical neurologic findings are extremely common in survivors of protracted critical illness. Neurophysiologic evidence of chronic partial denervation of muscle consistent with previous critical illness polyneuropathy is almost invariable and can be found up to 5 yrs after intensive care unit discharge in >90% of these long-stay patients. Evidence of myopathy is unusual. These findings have important implications for the management and rehabilitation of intensive care survivors. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/12682465/Persistent_neuromuscular_and_neurophysiologic_abnormalities_in_long_term_survivors_of_prolonged_critical_illness_ L2 - https://dx.doi.org/10.1097/01.CCM.0000053651.38421.D9 DB - PRIME DP - Unbound Medicine ER -