critical illness polyneuropathy
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Epidemiology
- 70% of patients with sepsis &/or critical illness
Pathology
- axonal polyneuropathy
- along with critical illness myopathy*, contributes to critical illness weakness
* critical illness myopathy often coexists with critical illness polyneuropathy[1]
Clinical manifestations
- distal limb weakness
- minimal sensory symptoms
- no autonomic symptoms
- not associated with cognitive impairment
- reduced to absent DTR
- dysphagia is common[3]
Diagnostic procedures
- early diagnosis with EMG & muscle biopsy
- swallowing study to evaluate for dysphagia
- presence of a tracheostomy tube should not prevent evaluation of swallowing function[3]
Complications
- inability to wean patients from ventilator
- prolonged post-hospitalization weakness[1]
Management
- early, aggressive rehabilitation
- appropriate glycemic control[1]
- minimize glucocorticoid use[1]
- treatment of weakness generally disappointing
- pureed diet generally adequate for patients with dysphagia
- dysphagia generally resolves within 30 days, independent of presence of tracheostomy tube[3]
More general terms
References
- ↑ Jump up to: 1.0 1.1 1.2 1.3 1.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
- ↑ Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G Interventions for preventing critical illness polyneuropathy and critical illness myopathy. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006832 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19160304
- ↑ Jump up to: 3.0 3.1 3.2 3.3 Ponfick M et al. Dysphagia - a common, transient symptom in critical illness polyneuropathy: A fiberoptic endoscopic evaluation of swallowing study. Crit Care Med 2015 Feb; 43:365 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25377021
- ↑ Chawla J, Gruener G. Management of critical illness polyneuropathy and myopathy. Neurol Clin. 2010 Nov;28(4):961-77. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20816273