Relaxation

Neuromuscular disorders in prolonged intensive care

Ilkka Parviainen, M.D. and Esko Ruokonen, M.D.

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Abstract

Muscle weakness is commonly found in critically ill patients. Traditionally, muscle weakness has been taken as a sign of catabolism associated with trauma, infection or multiple organ failure. Neuromuscular abnormalities associated with critical illness were recognized almost 30 years ago. Despite increased interest in this field the exact pathophysiologic mechanisms of various forms of neuromuscular abnormalities in the critically ill patient are not known. Neuromuscular disorders often manifest themselves as muscle weakness and the resulting clinical consequences can be prolonged weaning, extended ICU/hospital stay and rehabilitation. The degree of occurrence of neuromuscular disorders in the critically ill patients is not known, but it is conceivable that these disorders may contribute to prolongation of care in a substantial segment of the population.

Neuromuscular disorders can be classified according to three categories: myopathies, neuromuscular transmission disorders and polyneuropathy resulting from critical illness. Critical illness polyneuropathy is associated with sepsis and multiple organ failure. The transmission defects are commonly related to the use of neuromuscular blocking agents (NMBA) for a prolonged period. Neuromuscular (NMT) monitoring is helpful in avoiding levels of paralysis, which are too deep, and prolonged recovery. Myopathies, which present after the admission to an ICU, are relatively uncommon, and they are usually associated with sepsis. The use of corticosteroids and neuromuscular blocking agents may be related to the development of myopathy.The diagnosis of neuromuscular abnormalities is difficult in critically ill patients, because clinical judgement is of limited value. Neurophysiological investigations must be considered when clinical suspicion of critical illness polyneuropathy (weaning failure due to muscle weakness) exists. Muscle biopsy is indicated, if the patient presents a paresis without neural pathology. There are no specific treatment modalities for neuromuscular disorders; however, the awareness of their existence is helpful in care planning after the patient has recovered from the primary reason(s) for admission.

Last updated: 1 June 2000
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