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Greet Van Den Berghe - One of the best experts on this subject based on the ideXlab platform.
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interventions for preventing Critical Illness Polyneuropathy and Critical Illness myopathy
Cochrane Database of Systematic Reviews, 2014Co-Authors: Greet Hermans, Bernard De Jonghe, Frans Bruyninckx, Greet Van Den BergheAbstract:Background Critical Illness Polyneuropathy or myopathy (CIP/CIM) is a frequent complication in the intensive care unit (ICU) and is associated with prolonged mechanical ventilation, longer ICU stay and increased mortality. This is an interim update of a review first published in 2009 (Hermans 2009). It has been updated to October 2011, with further potentially eligible studies from a December 2013 search characterised as awaiting assessment. Objectives To systematically review the evidence from RCTs concerning the ability of any intervention to reduce the incidence of CIP or CIM in Critically ill individuals. Search methods On 4 October 2011, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, and EMBASE. We checked the bibliographies of identified trials and contacted trial authors and experts in the field. We carried out an additional search of these databases on 6 December 2013 to identify recent studies. Selection criteria All randomised controlled trials (RCTs), examining the effect of any intervention on the incidence of CIP/CIM in people admitted to adult medical or surgical ICUs. The primary outcome was the incidence of CIP/CIM in ICU, based on electrophysiological or clinical examination. Secondary outcomes included duration of mechanical ventilation, duration of ICU stay, death at 30 and 180 days after ICU admission and serious adverse events from the treatment regimens. Data collection and analysis Two authors independently extracted the data and assessed the risk of bias in included studies. Main results We identified five trials that met our inclusion criteria. Two trials compared intensive insulin therapy (IIT) to conventional insulin therapy (CIT). IIT significantly reduced CIP/CIM in the screened (n = 825; risk ratio (RR) 0.65, 95% confidence interval (CI) 0.55 to 0.77) and total (n = 2748; RR 0.70, 95% CI 0.60 to 0.82) population randomised. IIT reduced duration of mechanical ventilation, ICU stay and 180-day mortality, but not 30-day mortality compared with CIT. Hypoglycaemia increased with IIT but did not cause early deaths. One trial compared corticosteroids with placebo (n = 180). The trial found no effect of treatment on CIP/CIM (RR 1.27, 95% CI 0.77 to 2.08), 180-day mortality, new infections, glycaemia at day seven, or episodes of pneumonia, but did show a reduction of new shock events. In the fourth trial, early physical therapy reduced CIP/CIM in 82/104 evaluable participants in ICU (RR 0.62. 95% CI 0.39 to 0.96). Statistical significance was lost when we performed a full intention-to-treat analysis (RR 0.81, 95% CI 0.60 to 1.08). Duration of mechanical ventilation but not ICU stay was significantly shorter in the intervention group. Hospital mortality was not affected but 30- and 180-day mortality results were not available. No adverse effects were noticed. The last trial found a reduced incidence of CIP/CIM in 52 evaluable participants out of a total of 140 who were randomised to electrical muscle stimulation (EMS) versus no stimulation (RR 0.32, 95% CI 0.10 to 1.01). These data were prone to bias due to imbalances between treatment groups in this subgroup of participants. After we imputed missing data and performed an intention-to-treat analysis, there was still no significant effect (RR 0.94, 95% CI 0.78 to 1.15). The investigators found no effect on duration of mechanical ventilation and noted no difference in ICU mortality, but did not report 30- and 180-day mortality. We updated the searches in December 2013 and identified nine potentially eligible studies that will be assessed for inclusion in the next update of the review. Authors' conclusions There is moderate quality evidence from two large trials that intensive insulin therapy reduces CIP/CIM, and high quality evidence that it reduces duration of mechanical ventilation, ICU stay and 180-day mortality, at the expense of hypoglycaemia. Consequences and prevention of hypoglycaemia need further study. There is moderate quality evidence which suggests no effect of corticosteroids on CIP/CIM and high quality evidence that steroids do not affect secondary outcomes, except for fewer new shock episodes. Moderate quality evidence suggests a potential benefit of early rehabilitation on CIP/CIM which is accompanied by a shorter duration of mechanical ventilation but without an effect on ICU stay. Very low quality evidence suggests no effect of EMS, although data are prone to bias. Strict diagnostic criteria for CIP/CIM are urgently needed for research purposes. Large RCTs need to be conducted to further explore the role of early rehabilitation and EMS and to develop new preventive strategies.
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clinical review Critical Illness Polyneuropathy and myopathy
Critical Care, 2008Co-Authors: Greet Hermans, Bernard De Jonghe, Frans Bruyninckx, Greet Van Den BergheAbstract:Critical Illness Polyneuropathy (CIP) and myopathy (CIM) are major complications of severe Critical Illness and its management. CIP/CIM prolongs weaning from mechanical ventilation and physical rehabilitation since both limb and respiratory muscles can be affected. Among many risk factors implicated, sepsis, systemic inflammatory response syndrome, and multiple organ failure appear to play a crucial role in CIP/CIM. This review focuses on epidemiology, diagnostic challenges, the current understanding of pathophysiology, risk factors, important clinical consequences, and potential interventions to reduce the incidence of CIP/CIM. CIP/CIM is associated with increased hospital and intensive care unit (ICU) stays and increased mortality rates. Recently, it was shown in a single centre that intensive insulin therapy significantly reduced the electrophysiological incidence of CIP/CIM and the need for prolonged mechanical ventilation in patients in a medical or surgical ICU for at least 1 week. The electrophysiological diagnosis was limited by the fact that muscle membrane inexcitability was not detected. These results have yet to be confirmed in a larger patient population. One of the main risks of this therapy is hypoglycemia. Also, conflicting evidence concerning the neuromuscular effects of corticosteroids exists. A systematic review of the available literature on the optimal approach for preventing CIP/CIM seems warranted.
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review clinical review Critical Illness Polyneuropathy and myopathy
2008Co-Authors: Greet Hermans, Bernard De Jonghe, Frans Bruyninckx, Greet Van Den BergheAbstract:Critical Illness Polyneuropathy (CIP) and myopathy (CIM) are major complications of severe Critical Illness and its management. CIP/ CIM prolongs weaning from mechanical ventilation and physical rehabilitation since both limb and respiratory muscles can be affected. Among many risk factors implicated, sepsis, systemic inflammatory response syndrome, and multiple organ failure appear to play a crucial role in CIP/CIM. This review focuses on epidemiology, diagnostic challenges, the current understanding of pathophysiology, risk factors, important clinical consequences, and potential interventions to reduce the incidence of CIP/CIM. CIP/CIM is associated with increased hospital and intensive care unit (ICU) stays and increased mortality rates. Recently, it was shown in a single centre that intensive insulin therapy significantly reduced the electrophysiological incidence of CIP/CIM and the need for prolonged mechanical ventilation in patients in a medical or surgical ICU for at least 1 week. The electrophysiological diagnosis was limited by the fact that muscle membrane inexcitability was not detected. These results have yet to be confirmed in a larger patient population. One of the main risks of this therapy is hypoglycemia. Also, conflicting evidence concerning the neuromuscular effects of corticosteroids exists. A systematic review of the available literature on the optimal approach for preventing CIP/CIM seems warranted.
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impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit
American Journal of Respiratory and Critical Care Medicine, 2007Co-Authors: Greet Hermans, Frans Bruyninckx, Alexander Wilmer, Wouter Meersseman, Ilse Milants, Pieter J Wouters, Herman Bobbaers, Greet Van Den BergheAbstract:Rationale: Critical Illness Polyneuropathy/myopathy causes limb and respiratory muscle weakness, prolongs mechanical ventilation, and extends hospitalization of intensive care patients. Besides controlling risk factors, no specific prevention or treatment exists. Recently, intensive insulin therapy prevented Critical Illness Polyneuropathy in a surgical intensive care unit.Objectives: To investigate the impact of intensive insulin therapy on Polyneuropathy/myopathy and treatment with prolonged mechanical ventilation in medical patients in the intensive care unit for at least 7 days.Methods: This was a prospectively planned subanalysis of a randomized controlled trial evaluating the effect of intensive insulin versus conventional therapy on morbidity and mortality in Critically ill medical patients. All patients who were still in intensive care on Day 7 were screened weekly by electroneuromyography. The effect of intensive insulin therapy on Critical Illness Polyneuropathy/myopathy and the relationship wit...
Greet Hermans - One of the best experts on this subject based on the ideXlab platform.
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interventions for preventing Critical Illness Polyneuropathy and Critical Illness myopathy
Cochrane Database of Systematic Reviews, 2014Co-Authors: Greet Hermans, Bernard De Jonghe, Frans Bruyninckx, Greet Van Den BergheAbstract:Background Critical Illness Polyneuropathy or myopathy (CIP/CIM) is a frequent complication in the intensive care unit (ICU) and is associated with prolonged mechanical ventilation, longer ICU stay and increased mortality. This is an interim update of a review first published in 2009 (Hermans 2009). It has been updated to October 2011, with further potentially eligible studies from a December 2013 search characterised as awaiting assessment. Objectives To systematically review the evidence from RCTs concerning the ability of any intervention to reduce the incidence of CIP or CIM in Critically ill individuals. Search methods On 4 October 2011, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, and EMBASE. We checked the bibliographies of identified trials and contacted trial authors and experts in the field. We carried out an additional search of these databases on 6 December 2013 to identify recent studies. Selection criteria All randomised controlled trials (RCTs), examining the effect of any intervention on the incidence of CIP/CIM in people admitted to adult medical or surgical ICUs. The primary outcome was the incidence of CIP/CIM in ICU, based on electrophysiological or clinical examination. Secondary outcomes included duration of mechanical ventilation, duration of ICU stay, death at 30 and 180 days after ICU admission and serious adverse events from the treatment regimens. Data collection and analysis Two authors independently extracted the data and assessed the risk of bias in included studies. Main results We identified five trials that met our inclusion criteria. Two trials compared intensive insulin therapy (IIT) to conventional insulin therapy (CIT). IIT significantly reduced CIP/CIM in the screened (n = 825; risk ratio (RR) 0.65, 95% confidence interval (CI) 0.55 to 0.77) and total (n = 2748; RR 0.70, 95% CI 0.60 to 0.82) population randomised. IIT reduced duration of mechanical ventilation, ICU stay and 180-day mortality, but not 30-day mortality compared with CIT. Hypoglycaemia increased with IIT but did not cause early deaths. One trial compared corticosteroids with placebo (n = 180). The trial found no effect of treatment on CIP/CIM (RR 1.27, 95% CI 0.77 to 2.08), 180-day mortality, new infections, glycaemia at day seven, or episodes of pneumonia, but did show a reduction of new shock events. In the fourth trial, early physical therapy reduced CIP/CIM in 82/104 evaluable participants in ICU (RR 0.62. 95% CI 0.39 to 0.96). Statistical significance was lost when we performed a full intention-to-treat analysis (RR 0.81, 95% CI 0.60 to 1.08). Duration of mechanical ventilation but not ICU stay was significantly shorter in the intervention group. Hospital mortality was not affected but 30- and 180-day mortality results were not available. No adverse effects were noticed. The last trial found a reduced incidence of CIP/CIM in 52 evaluable participants out of a total of 140 who were randomised to electrical muscle stimulation (EMS) versus no stimulation (RR 0.32, 95% CI 0.10 to 1.01). These data were prone to bias due to imbalances between treatment groups in this subgroup of participants. After we imputed missing data and performed an intention-to-treat analysis, there was still no significant effect (RR 0.94, 95% CI 0.78 to 1.15). The investigators found no effect on duration of mechanical ventilation and noted no difference in ICU mortality, but did not report 30- and 180-day mortality. We updated the searches in December 2013 and identified nine potentially eligible studies that will be assessed for inclusion in the next update of the review. Authors' conclusions There is moderate quality evidence from two large trials that intensive insulin therapy reduces CIP/CIM, and high quality evidence that it reduces duration of mechanical ventilation, ICU stay and 180-day mortality, at the expense of hypoglycaemia. Consequences and prevention of hypoglycaemia need further study. There is moderate quality evidence which suggests no effect of corticosteroids on CIP/CIM and high quality evidence that steroids do not affect secondary outcomes, except for fewer new shock episodes. Moderate quality evidence suggests a potential benefit of early rehabilitation on CIP/CIM which is accompanied by a shorter duration of mechanical ventilation but without an effect on ICU stay. Very low quality evidence suggests no effect of EMS, although data are prone to bias. Strict diagnostic criteria for CIP/CIM are urgently needed for research purposes. Large RCTs need to be conducted to further explore the role of early rehabilitation and EMS and to develop new preventive strategies.
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clinical review Critical Illness Polyneuropathy and myopathy
Critical Care, 2008Co-Authors: Greet Hermans, Bernard De Jonghe, Frans Bruyninckx, Greet Van Den BergheAbstract:Critical Illness Polyneuropathy (CIP) and myopathy (CIM) are major complications of severe Critical Illness and its management. CIP/CIM prolongs weaning from mechanical ventilation and physical rehabilitation since both limb and respiratory muscles can be affected. Among many risk factors implicated, sepsis, systemic inflammatory response syndrome, and multiple organ failure appear to play a crucial role in CIP/CIM. This review focuses on epidemiology, diagnostic challenges, the current understanding of pathophysiology, risk factors, important clinical consequences, and potential interventions to reduce the incidence of CIP/CIM. CIP/CIM is associated with increased hospital and intensive care unit (ICU) stays and increased mortality rates. Recently, it was shown in a single centre that intensive insulin therapy significantly reduced the electrophysiological incidence of CIP/CIM and the need for prolonged mechanical ventilation in patients in a medical or surgical ICU for at least 1 week. The electrophysiological diagnosis was limited by the fact that muscle membrane inexcitability was not detected. These results have yet to be confirmed in a larger patient population. One of the main risks of this therapy is hypoglycemia. Also, conflicting evidence concerning the neuromuscular effects of corticosteroids exists. A systematic review of the available literature on the optimal approach for preventing CIP/CIM seems warranted.
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implementing intensive insulin therapy in daily practice reduces the incidence of Critical Illness Polyneuropathy and or myopathy
Critical Care, 2008Co-Authors: N Berends, Greet Hermans, B Bouckaert, P Van Damme, Maarten Schrooten, W De Vooght, Pieter Wouters, G Van Den BergheAbstract:In two randomised controlled trials (RCTs) on the effect of intensive insulin therapy (IIT) in a surgical ICU (SICU) and a medical ICU (MICU), IIT reduced the incidence of Critical Illness Polyneuropathy and/or myopathy (CIP/CIM) and the need for prolonged mechanical ventilation (MV ≥ 14 days). Here we investigated whether these effects are present in daily practice when IIT is implemented outside a study protocol.
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review clinical review Critical Illness Polyneuropathy and myopathy
2008Co-Authors: Greet Hermans, Bernard De Jonghe, Frans Bruyninckx, Greet Van Den BergheAbstract:Critical Illness Polyneuropathy (CIP) and myopathy (CIM) are major complications of severe Critical Illness and its management. CIP/ CIM prolongs weaning from mechanical ventilation and physical rehabilitation since both limb and respiratory muscles can be affected. Among many risk factors implicated, sepsis, systemic inflammatory response syndrome, and multiple organ failure appear to play a crucial role in CIP/CIM. This review focuses on epidemiology, diagnostic challenges, the current understanding of pathophysiology, risk factors, important clinical consequences, and potential interventions to reduce the incidence of CIP/CIM. CIP/CIM is associated with increased hospital and intensive care unit (ICU) stays and increased mortality rates. Recently, it was shown in a single centre that intensive insulin therapy significantly reduced the electrophysiological incidence of CIP/CIM and the need for prolonged mechanical ventilation in patients in a medical or surgical ICU for at least 1 week. The electrophysiological diagnosis was limited by the fact that muscle membrane inexcitability was not detected. These results have yet to be confirmed in a larger patient population. One of the main risks of this therapy is hypoglycemia. Also, conflicting evidence concerning the neuromuscular effects of corticosteroids exists. A systematic review of the available literature on the optimal approach for preventing CIP/CIM seems warranted.
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impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit
American Journal of Respiratory and Critical Care Medicine, 2007Co-Authors: Greet Hermans, Frans Bruyninckx, Alexander Wilmer, Wouter Meersseman, Ilse Milants, Pieter J Wouters, Herman Bobbaers, Greet Van Den BergheAbstract:Rationale: Critical Illness Polyneuropathy/myopathy causes limb and respiratory muscle weakness, prolongs mechanical ventilation, and extends hospitalization of intensive care patients. Besides controlling risk factors, no specific prevention or treatment exists. Recently, intensive insulin therapy prevented Critical Illness Polyneuropathy in a surgical intensive care unit.Objectives: To investigate the impact of intensive insulin therapy on Polyneuropathy/myopathy and treatment with prolonged mechanical ventilation in medical patients in the intensive care unit for at least 7 days.Methods: This was a prospectively planned subanalysis of a randomized controlled trial evaluating the effect of intensive insulin versus conventional therapy on morbidity and mortality in Critically ill medical patients. All patients who were still in intensive care on Day 7 were screened weekly by electroneuromyography. The effect of intensive insulin therapy on Critical Illness Polyneuropathy/myopathy and the relationship wit...
Frans Bruyninckx - One of the best experts on this subject based on the ideXlab platform.
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interventions for preventing Critical Illness Polyneuropathy and Critical Illness myopathy
Cochrane Database of Systematic Reviews, 2014Co-Authors: Greet Hermans, Bernard De Jonghe, Frans Bruyninckx, Greet Van Den BergheAbstract:Background Critical Illness Polyneuropathy or myopathy (CIP/CIM) is a frequent complication in the intensive care unit (ICU) and is associated with prolonged mechanical ventilation, longer ICU stay and increased mortality. This is an interim update of a review first published in 2009 (Hermans 2009). It has been updated to October 2011, with further potentially eligible studies from a December 2013 search characterised as awaiting assessment. Objectives To systematically review the evidence from RCTs concerning the ability of any intervention to reduce the incidence of CIP or CIM in Critically ill individuals. Search methods On 4 October 2011, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, and EMBASE. We checked the bibliographies of identified trials and contacted trial authors and experts in the field. We carried out an additional search of these databases on 6 December 2013 to identify recent studies. Selection criteria All randomised controlled trials (RCTs), examining the effect of any intervention on the incidence of CIP/CIM in people admitted to adult medical or surgical ICUs. The primary outcome was the incidence of CIP/CIM in ICU, based on electrophysiological or clinical examination. Secondary outcomes included duration of mechanical ventilation, duration of ICU stay, death at 30 and 180 days after ICU admission and serious adverse events from the treatment regimens. Data collection and analysis Two authors independently extracted the data and assessed the risk of bias in included studies. Main results We identified five trials that met our inclusion criteria. Two trials compared intensive insulin therapy (IIT) to conventional insulin therapy (CIT). IIT significantly reduced CIP/CIM in the screened (n = 825; risk ratio (RR) 0.65, 95% confidence interval (CI) 0.55 to 0.77) and total (n = 2748; RR 0.70, 95% CI 0.60 to 0.82) population randomised. IIT reduced duration of mechanical ventilation, ICU stay and 180-day mortality, but not 30-day mortality compared with CIT. Hypoglycaemia increased with IIT but did not cause early deaths. One trial compared corticosteroids with placebo (n = 180). The trial found no effect of treatment on CIP/CIM (RR 1.27, 95% CI 0.77 to 2.08), 180-day mortality, new infections, glycaemia at day seven, or episodes of pneumonia, but did show a reduction of new shock events. In the fourth trial, early physical therapy reduced CIP/CIM in 82/104 evaluable participants in ICU (RR 0.62. 95% CI 0.39 to 0.96). Statistical significance was lost when we performed a full intention-to-treat analysis (RR 0.81, 95% CI 0.60 to 1.08). Duration of mechanical ventilation but not ICU stay was significantly shorter in the intervention group. Hospital mortality was not affected but 30- and 180-day mortality results were not available. No adverse effects were noticed. The last trial found a reduced incidence of CIP/CIM in 52 evaluable participants out of a total of 140 who were randomised to electrical muscle stimulation (EMS) versus no stimulation (RR 0.32, 95% CI 0.10 to 1.01). These data were prone to bias due to imbalances between treatment groups in this subgroup of participants. After we imputed missing data and performed an intention-to-treat analysis, there was still no significant effect (RR 0.94, 95% CI 0.78 to 1.15). The investigators found no effect on duration of mechanical ventilation and noted no difference in ICU mortality, but did not report 30- and 180-day mortality. We updated the searches in December 2013 and identified nine potentially eligible studies that will be assessed for inclusion in the next update of the review. Authors' conclusions There is moderate quality evidence from two large trials that intensive insulin therapy reduces CIP/CIM, and high quality evidence that it reduces duration of mechanical ventilation, ICU stay and 180-day mortality, at the expense of hypoglycaemia. Consequences and prevention of hypoglycaemia need further study. There is moderate quality evidence which suggests no effect of corticosteroids on CIP/CIM and high quality evidence that steroids do not affect secondary outcomes, except for fewer new shock episodes. Moderate quality evidence suggests a potential benefit of early rehabilitation on CIP/CIM which is accompanied by a shorter duration of mechanical ventilation but without an effect on ICU stay. Very low quality evidence suggests no effect of EMS, although data are prone to bias. Strict diagnostic criteria for CIP/CIM are urgently needed for research purposes. Large RCTs need to be conducted to further explore the role of early rehabilitation and EMS and to develop new preventive strategies.
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clinical review Critical Illness Polyneuropathy and myopathy
Critical Care, 2008Co-Authors: Greet Hermans, Bernard De Jonghe, Frans Bruyninckx, Greet Van Den BergheAbstract:Critical Illness Polyneuropathy (CIP) and myopathy (CIM) are major complications of severe Critical Illness and its management. CIP/CIM prolongs weaning from mechanical ventilation and physical rehabilitation since both limb and respiratory muscles can be affected. Among many risk factors implicated, sepsis, systemic inflammatory response syndrome, and multiple organ failure appear to play a crucial role in CIP/CIM. This review focuses on epidemiology, diagnostic challenges, the current understanding of pathophysiology, risk factors, important clinical consequences, and potential interventions to reduce the incidence of CIP/CIM. CIP/CIM is associated with increased hospital and intensive care unit (ICU) stays and increased mortality rates. Recently, it was shown in a single centre that intensive insulin therapy significantly reduced the electrophysiological incidence of CIP/CIM and the need for prolonged mechanical ventilation in patients in a medical or surgical ICU for at least 1 week. The electrophysiological diagnosis was limited by the fact that muscle membrane inexcitability was not detected. These results have yet to be confirmed in a larger patient population. One of the main risks of this therapy is hypoglycemia. Also, conflicting evidence concerning the neuromuscular effects of corticosteroids exists. A systematic review of the available literature on the optimal approach for preventing CIP/CIM seems warranted.
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review clinical review Critical Illness Polyneuropathy and myopathy
2008Co-Authors: Greet Hermans, Bernard De Jonghe, Frans Bruyninckx, Greet Van Den BergheAbstract:Critical Illness Polyneuropathy (CIP) and myopathy (CIM) are major complications of severe Critical Illness and its management. CIP/ CIM prolongs weaning from mechanical ventilation and physical rehabilitation since both limb and respiratory muscles can be affected. Among many risk factors implicated, sepsis, systemic inflammatory response syndrome, and multiple organ failure appear to play a crucial role in CIP/CIM. This review focuses on epidemiology, diagnostic challenges, the current understanding of pathophysiology, risk factors, important clinical consequences, and potential interventions to reduce the incidence of CIP/CIM. CIP/CIM is associated with increased hospital and intensive care unit (ICU) stays and increased mortality rates. Recently, it was shown in a single centre that intensive insulin therapy significantly reduced the electrophysiological incidence of CIP/CIM and the need for prolonged mechanical ventilation in patients in a medical or surgical ICU for at least 1 week. The electrophysiological diagnosis was limited by the fact that muscle membrane inexcitability was not detected. These results have yet to be confirmed in a larger patient population. One of the main risks of this therapy is hypoglycemia. Also, conflicting evidence concerning the neuromuscular effects of corticosteroids exists. A systematic review of the available literature on the optimal approach for preventing CIP/CIM seems warranted.
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impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit
American Journal of Respiratory and Critical Care Medicine, 2007Co-Authors: Greet Hermans, Frans Bruyninckx, Alexander Wilmer, Wouter Meersseman, Ilse Milants, Pieter J Wouters, Herman Bobbaers, Greet Van Den BergheAbstract:Rationale: Critical Illness Polyneuropathy/myopathy causes limb and respiratory muscle weakness, prolongs mechanical ventilation, and extends hospitalization of intensive care patients. Besides controlling risk factors, no specific prevention or treatment exists. Recently, intensive insulin therapy prevented Critical Illness Polyneuropathy in a surgical intensive care unit.Objectives: To investigate the impact of intensive insulin therapy on Polyneuropathy/myopathy and treatment with prolonged mechanical ventilation in medical patients in the intensive care unit for at least 7 days.Methods: This was a prospectively planned subanalysis of a randomized controlled trial evaluating the effect of intensive insulin versus conventional therapy on morbidity and mortality in Critically ill medical patients. All patients who were still in intensive care on Day 7 were screened weekly by electroneuromyography. The effect of intensive insulin therapy on Critical Illness Polyneuropathy/myopathy and the relationship wit...
Koichi Hirata - One of the best experts on this subject based on the ideXlab platform.
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distinctions between Critical Illness Polyneuropathy and axonal guillain barre syndrome
Journal of Neurology Neurosurgery and Psychiatry, 1999Co-Authors: Nobuhiro Yuki, Koichi HirataAbstract:In this letter we comment on the publication of Yuki and Hirata who postulate a possible relation between Critical Illness Polyneuropathy and axonal Guillain-Barre syndrome.1 The authors mentioned a nosological relation, which at that time still had to be demonstrated by the presence of antiganglioside antibodies in the serum of patients with Critical Illness Polyneuropathy. Critical Illness Polyneuropathy is a neuromuscular disorder that has been recognised in Critically ill patients.2 The clinical picture consists of difficulty in weaning from the artificial respirator, tetraparesis, and muscle wasting of the limbs. The tendon reflexes are mostly decreased or absent. The neurophysiological examination shows an axonal Polyneuropathy and sometimes myopathic altered motor unit potentials. The morphological features in the nerve point to a primarily distal axonal degeneration of motor and sensory fibres. Muscle biopsy shows scattered atrophic fibres in acute denervation and grouped atrophy in chronic denervation. Also, necrotic muscle fibres can be found suggesting the contribution of a myopathy or a primary myopathy.3 On clinical … Dr. Nobuhiro Yuki, Department of Neurology, Dokkyo University School of Medicine, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi 321–0293, Japan.
Charles F. Bolton - One of the best experts on this subject based on the ideXlab platform.
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Critical Illness Polyneuropathy and myopathy a major cause of muscle weakness and paralysis
Lancet Neurology, 2011Co-Authors: Nicola Latronico, Charles F. BoltonAbstract:Critical Illness Polyneuropathy (CIP) and myopathy (CIM) are complications of Critical Illness that present with muscle weakness and failure to wean from the ventilator. In addition to prolonging mechanical ventilation and hospitalisation, CIP and CIM increase hospital mortality in patients who are Critically ill and cause chronic disability in survivors of Critical Illness. Structural changes associated with CIP and CIM include axonal nerve degeneration, muscle myosin loss, and muscle necrosis. Functional changes can cause electrical inexcitability of nerves and muscles with reversible muscle weakness. Microvascular changes and cytopathic hypoxia might disrupt energy supply and use. An acquired sodium channelopathy causing reduced muscle membrane and nerve excitability is a possible unifying mechanism underlying CIP and CIM. The diagnosis of CIP, CIM, or combined CIP and CIM relies on clinical, electrophysiological, and muscle biopsy investigations. Control of hyperglycaemia might reduce the severity of these complications of Critical Illness, and early rehabilitation in the intensive care unit might improve the functional recovery and independence of patients.
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The discovery of Critical Illness Polyneuropathy.
European Journal of Anaesthesiology, 2008Co-Authors: Charles F. BoltonAbstract:In 1892 Osler described 'rapid loss of flesh' in prolonged sepsis. Thereafter, for years, limb weakness was attributed to cachectic myopathy, and difficulty weaning from mechanical ventilation was attributed to diaphragmatic fatigue. In 1961 Mertens described 'coma-polyneuropathies', and in 1971 Henderson and colleagues described Polyneuropathy in patients with burns. In 1984 Bolton and colleagues, in a series of reports, defined the clinical, electrophysiological and morphological features of septic encephalopathy and Critical Illness Polyneuropathy. Evidence suggested that Polyneuropathy was due to the 'toxic' effects of sepsis. Polyneuropathy was a common cause of difficulty in weaning when lung and cardiac cause had been excluded. Since 1984, cases of Critical Illness Polyneuropathy have been reported from several countries. Moreover, a number of investigators reported instances of Critical Illness myopathy. Comprehensive studies by Latronico and colleagues indicated that Polyneuropathy and myopathy often occurred together in the same patient. With successful treatment of sepsis, improvement often occurred in encephalopathy, Polyneuropathy and myopathy, except in very severe cases.
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Critical Illness Polyneuropathy
Current Treatment Options in Neurology, 2000Co-Authors: Charles F. Bolton, G. Bryan YoungAbstract:Critical Illness Polyneuropathy (CIP) is common among patients in intensive care units (ICUs) [1, Class III]. However, it is rarely diagnosed in patients in most ICUs, because of the lack of knowledge, difficulties in clinical assessment, and failure to perform electrophysiologic studies. Nonetheless, CIP is a significant cause of difficulty in weaning patients from the ventilator and of long-term morbidity in survivors. Although no specific treatment is available, diagnosis is important for the institution of various nonspecific treatments and for prognosis. Moreover, research is important in arriving at a better understanding of the pathophysiologic mechanisms and, hence, possible avenues of specific treatment. Thus, this chapter emphasizes the nature of Critical Illness and the possible pathophysiology, the clinical and electrophysiologic features, and the differential diagnosis of CIP. Nonspecific and potential specific treatments are also discussed.
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clinical and electrophysiological findings in Critical Illness Polyneuropathy
Journal of the Neurological Sciences, 1998Co-Authors: Udo A Zifko, Harald T Zipko, Charles F. BoltonAbstract:Sixty two patients with Critical Illness Polyneuropathy (CIP) were studied prospectively to determine the clinical and electrophysiological profile, to assess the prognostic value of respiratory electrophysiology in determining the duration of ventilation and to analyze the role of neuromuscular blocking agents (NMBA) and steroids. Limb motor and sensory nerve conductions, bilateral phrenic nerve onset latencies, bilateral diaphragmatic compound muscle action potentials (CMAP), unilateral diaphragmatic needle electromyography (EMG), limb muscle EMG, time on the ventilator, time in the intensive care unit (ICU), dosage of NMBA and steroids were analyzed in 62 patients. The diagnosis of CIP was made by clinical criteria, electrophysiological criteria and exclusion of any other condition suspicious of an axonal neuropathy. The results of phrenic nerve conduction studies and diaphragmatic EMG were compared to normal mean values in 25 healthy subjects. The most common finding in our study were reduced CMAPs and abnormal spontaneous activity in muscle, occuring in 100%. Forty per cent had reduced CMAPs but normal sensory nerve action potentials (SNAP). These patients had normal CK-levels and normal findings, unspecific changes, type 2 fibre atrophy or denervation atrophy on muscle biopsy. Seventy seven per cent of patients had abnormal diaphragmatic CMAPs and spontaneous activity in the diaphragm indicating denervation of the diaphragm is common in CIP. There was no statistically significant relationship to the dosage of NMBA and steroids, and the respiratory electrophysiological studies, duration of ventilation and stay in the ICU.