The Incidence And Clinical Consequence Of Critical Illness Neuromyopathy In The Neurologic Intensive Care Unit

The development of ICU makes the improved survival of critically ill patients.more patients can receive a long-time treatment in ICU.However many ICU patients who often survive their illness has been prone to has symptoms like difficult weaning,paresis or paralysis of limbs,the decrease of tendon reflex and muscle weakness and atrophy and so on.This condition terms as critical illness neuromyopathy(CIPNM).Once combined with critical illness neuromyopathy(CIPNM),there came with not only the prolongation of mechanical ventilation time,the increase of hospitalization time,or the increase of in-hospital mortality,but also the long-term prognosis of critically ill patients,which can cause serious economic burden to patients,their families and the society.However,there is little research focus on the incidence and risk factors of critical illness neuromyopathy(CIPNM)in neurologic intensive care unit(NCU),and its impact on the prognosis of neurocritical patients.Objective:To determine the incidence,risk factors,electrophysiological characteristics and clinical consequence of critical illness neuromyopathy(CIPNM)in the neurologic intensive care unit that evaluate the development of critical illness neuromyopathy(CIPNM)by electrophysiology.Materials and methods:This is a prospective study carried out in the Neurologic Intensive Care Unit of the Nanfang Hospital in Guangzhou with teaching accreditation.From December 2016 to July 2017,all patient hospitalized in were followed.But only those meet the inclusion criteria were collected.The inclusion criteria were(1)The first time of hospitalization in Neurologic Intensive Care Unit as serious illness who featured simplified acute physiology(SAPS II)scores of 20 or higher in hospital;(2)The totle stay of Neurologic Intensive Care Unit is seven days or longer;(3)The nerve conduction velocity test for the first time in hospital is normal.Exclusion criteria were:(1)History,signs and symptoms of pre-existing neuromuscular disease were reported.(2)The eletrophysiological measurements can not be done.(3)End-stage disease.Each patient will have the eletrophysiological measurements done at first,4th,7th,14th,and 28th days in hospital until the patient was discharged or died.CIP and CIM were identified by direct muscle stimulation(DMS)in patients whom were considered as CIPNM.A unified form was used to record the demographic data and clinical data of patients.Functional outcome was measured by modified Rankin Scale(mRS),with mRS of 0-2 regarded as good outcome,mRS of 5-6 as poor outcome.They were obtained from family members through telephone interviews by a neurologist well-trained as the information on survival and functional outcome of these who discharged from NCU after 30d and 90d.Results:By the inclusion and exclusion criteria,a total of 54 NCU patients(33 males and 21 females)were included in the study.Among the 54 enrolled patients,critical illness neuromyopathy(CIPNM)were developed in 14 cases(25.9%),and all of these 14 patients developed in NCU.With the increase of stay in NCU,the proportion of critically ill patients with critical illness neuromyopathy(CIPNM)increased gradually.When the stay of NCU was as long as 28 days,the proportion of patients with critical illness neuromyopathy(CIPNM)was as high as 87.5%.The risk factors were mainly related to the severity of the disease(APACHE II score),the combination of Sepsis and MODS in NCU.And the lowest SOFA score and SAPS II score within 7 days in hospital could effectively predict the occurrence of critical illness neuromyopathy(CIPNM).Survival patients after NCU discharge were followed and we found that the occurrence of critical illness neuromyopathy(CIPNM)in hospitalization was associated with poor prognosis of patients after discharge,including short-term prognosis(30 days after NCU discharge)and long-term prognosis(90 days after NCU discharge),while without critical illness neuromyopathy(CIPNM)during NCU hospitalization could not indicate good prognosis after discharge.Conclusion:Critical illness neuromyopathy(CIPNM),with a high incidence,is a common complication of critically ill patients in critical care unit.With the prolongation of hospitalization in NCU,the incidence of critical illness neuromyopathy(CIPNM)is increasing.The occurrence of Sepsis during NCU hospitalization is an independent risk factor for the occurrence of CIPNM.Meanwhile,the occurrence of CIPNM during NCU hospitalization is an independent risk factor for poor prognosis after discharge in patients with neurocritical illness both short term(30 days after NCU discharge)and long term(90 days after NCU discharge).The prevention and treatment strategy of critical illness neuromyopathy(CIPNM)deserves more attention.