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October 18, 1995, Vol 274, No. 15 >
ARTICLE | October 18, 1995

The Role of Polyneuropathy in Motor Convalescence After Prolonged Mechanical Ventilation FREE

Frans S. S. Leijten, MD; Joukje E. Harinck-de Weerd, MD; Dick C. J. Poortvliet, MSc; Al W. de Weerd, MD, PhD
[+] Author Affiliations

Deceased.

Corresponding author: Frans S. S. Leijten, MD, Department of Clinical Neurophysiology, Meer en Bosch, PO Box 21, 2100 AA Heemstede, the Netherlands.


JAMA. 1995;274(15):1221-1225. doi:10.1001/jama.1995.03530150045032
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References

Objective.  —To test the hypothesis that prolonged motor recovery after long-term ventilation may be due to polyneuropathy and can be foreseen at an early stage by electromyography (EMG).

Design.  —Cohort study with an entry period of 18 months. Polyneuropathy was identified by EMG studies in the intensive care unit (ICU). During a 1-year follow-up, amount of time was recorded to reach a rehabilitation end point.

Setting.  —The general ICU of a community hospital.

Patients.  —Fifty patients younger than 75 years who were receiving mechanical ventilation for more than 7 days.

Main Outcome Measures.  —A rehabilitation end point was defined as return of normal muscle strength and ability to walk 50 m independently.

Results.  —In 29 of 50 patients, an EMG diagnosis of polyneuropathy was made in the ICU. Patients with polyneuropathy had a higher mortality in the ICU (14 vs 4; P=.03), probably related to multiple organ failure (22 vs 11; P=.08) or aminoglycoside treatment of suspected gram-negative sepsis (17 vs 4; P=.05). Rehabilitation was more prolonged in 12 patients with polyneuropathy than in 12 without polyneuropathy (P=.001). Of nine patients with delays beyond 4 weeks, eight had polyneuropathy, five of whom had persistent motor handicap after 1 year. In particular, axonal polyneuropathy with conduction slowing on EMG indicated a poor prognosis.

Conclusions.  —Polyneuropathy in the critically ill is related to multiple organ failure and gram-negative sepsis, is associated with higher mortality, and causes important rehabilitation problems. EMG recordings in the ICU can identify patients at risk.(JAMA. 1995;274:1221-1225)

REFERENCES

1 +
Repine JE.  Scientific perspectives on adult respiratory distress syndrome. Lancet . 1992;;339:466-469.
2 +
Kelly BJ, Matthay MA.  Prevalence and severity of neurologic dysfunction in critically ill patients. Chest . 1993;;104:1818-1824.
3 +
Roelofs RJ, Cerra F, Bielka N, Rosenberg L, Delaney J.  Prolonged respiratory insufficiency due to acute motor neuropathy: a new syndrome? Neurology . 1983;;33( (suppl 2) ):240.
4 +
Rivner MH, Kim S, Greenberg M, Swift TR.  Reversible generalized paresis following hypotension. Neurology . 1983;;33( (suppl 2) ):164.
5 +
Op de Coul AAW, Lambregts PCLA, Koeman J, Van Puyenbroek MJE, Palmen FMLHG.  Neuromuscular complications after artificial respiration with Pavulon (pancuronium bromide). Clin Neurol Neurosurg . 1983;;85:197.
6 +
Bolton CF, Brown JD, Sibbald WJ.  The electrophysiologic investigation of respiratory paralysis in critically ill patients. Neurology . 1983;;33( (suppl 2) ):186.
7 +
Bolton CF, Laverty DA, Brown JD, Witt NJ, Hahn AF, Sibbald WJ.  Critically ill polyneuropathy: electrophysiological studies and differentiation from Guillain—Barré syndrome. J Neurol Neurosurg Psychiatry . 1986;;49:563-573.
8 +
Zochodne DW, Bolton CF, Wells GA, et al.  Critical illness polyneuropathy: a complication of sepsis and multiple organ failure. Brain . 1987;;110:819-842.
9 +
Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ.  Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry . 1984;;47:1223-1231.
10 +
Op de Coul AAW, Lambregts PCLA, Koeman J, Van Puyenbroek MJE, Ter Laak HJ, Gabreës-Festen AAWM.  Neuromuscular complications in patients given Pavulon (pancuronium bromide) during artificial ventilation. Clin Neurol Neurosurg . 1985;;87:17-22.
11 +
Williams AC, Sturman S, Kelsey S, Curran FT, Finnegan JA.  The neuropathy of the critically ill. BMJ . 1986;;293:790-791.
12 +
Lycklama à Nijholt J, Troost J.  Critical illness polyneuropathy.  In: Matthews WB, ed. Handbook of Clinical Neurology: Neuropathies . Amsterdam, the Netherlands: Elsevier Science Publishers; 1987;; 7:575-585.
13 +
Barat M, Brochet B, Vital C, Mazaux JM, Arné L.  Polyneuropathies au cours de séjours prolongés en réanimation. Rev Neurol . 1987;;143:823-831.
14 +
Coronel B, Mercatello A, Couturier JC, et al.  Polyneuropathy: potential cause of difficult weaning. Crit Care Med . 1990;;18:486-489.
15 +
Lopez Messa JB, García A.  Acute polyneuropathy in critically ill patients. Intensive Care Med . 1990;;16:159-162.
16 +
Gorson KC, Ropper AH.  Acute respiratory failure neuropathy: a variant of critical illness polyneuropathy. Crit Care Med . 1993;;21:267-271.
17 +
Leijten FSS, De Weerd AW.  Critical illness polyneuropathy: a review of the literature, definition, and pathophysiology. Clin Neurol Neurosurg . 1994;;96:10-19.
18 +
Witt NJ, Zochodne DW, Bolton CF, et al.  Peripheral nerve function in sepsis and multiple organ failure. Chest . 1991;;99:176-184.
19 +
Spitzer AR, Giancarlo T, Maher L, Awerbuch G, Bowles A.  Neuromuscular causes of prolonged ventilator dependency. Muscle Nerve . 1992;;15:682-686.
20 +
Coakley JH, Nagendran K, Honavar M, Hinds CJ.  Preliminary observations on the neuromuscular abnormalities in patients with organ failure and sepsis. Intensive Care Med . 1993;;19:323-328.
21 +
Sprung CL.  Definitions of spesis—have we reached a consensus? Crit Care Med . 1991;;19:849-851.
22 +
Lemaire F.  Difficult weaning. Intensive Care Med . 1993;;19( (suppl) ):S69-S73.
23 +
Op de Coul AAW, Verheul GAM, Leijten ACM, Schellens RLLA, Teepen JLJM.  Critical illness polyneuromyopathy after artificial respiration. Clin Neurol Neurosurg . 1991;;93:27-33.
24 +
Seiser A, Schwarz S, Brainin M.  Critical illness polyneuropathie: Klinik und Langzeitergebnisse. Wien Klin Wochenschr . 1992;;104:294-300.
25 +
Bone RC, Balk RA, Cerra FB, et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest . 1992;; 101:1644-1655.
26 +
Goris RJA, te Boekhorst TPA, Nuytinck JKS, Gimbrère JSF.  Multiple-organ failure: generalized autodestructive inflammation? Arch Surg . 1985;;120: 1109-1115.
27 +
Asbury AK, Cornblath DR.  Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol . 1990;;27( (suppl) ):S21-S24.
28 +
Medical Research Council. Aids to the Investigation of the Peripheral Nervous System . London, England: Her Majesty's Stationary Office; 1976;.
29 +
Knaus WA, Draper EA, Wagner DP, Zimmerman JE.  APACHE II: a severity of disease classification system. Crit Care Med . 1985;;13:818-829.
30 +
Dodson BA, Kelly BJ, Braswell LM, Cohen NH.  Changes in acetylcholine receptor number in muscle from critically ill patients receiving muscle relaxants. Crit Care Med . 1995;;23:815-821.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Repine JE.  Scientific perspectives on adult respiratory distress syndrome. Lancet . 1992;;339:466-469.
2 +
Kelly BJ, Matthay MA.  Prevalence and severity of neurologic dysfunction in critically ill patients. Chest . 1993;;104:1818-1824.
3 +
Roelofs RJ, Cerra F, Bielka N, Rosenberg L, Delaney J.  Prolonged respiratory insufficiency due to acute motor neuropathy: a new syndrome? Neurology . 1983;;33( (suppl 2) ):240.
4 +
Rivner MH, Kim S, Greenberg M, Swift TR.  Reversible generalized paresis following hypotension. Neurology . 1983;;33( (suppl 2) ):164.
5 +
Op de Coul AAW, Lambregts PCLA, Koeman J, Van Puyenbroek MJE, Palmen FMLHG.  Neuromuscular complications after artificial respiration with Pavulon (pancuronium bromide). Clin Neurol Neurosurg . 1983;;85:197.
6 +
Bolton CF, Brown JD, Sibbald WJ.  The electrophysiologic investigation of respiratory paralysis in critically ill patients. Neurology . 1983;;33( (suppl 2) ):186.
7 +
Bolton CF, Laverty DA, Brown JD, Witt NJ, Hahn AF, Sibbald WJ.  Critically ill polyneuropathy: electrophysiological studies and differentiation from Guillain—Barré syndrome. J Neurol Neurosurg Psychiatry . 1986;;49:563-573.
8 +
Zochodne DW, Bolton CF, Wells GA, et al.  Critical illness polyneuropathy: a complication of sepsis and multiple organ failure. Brain . 1987;;110:819-842.
9 +
Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ.  Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry . 1984;;47:1223-1231.
10 +
Op de Coul AAW, Lambregts PCLA, Koeman J, Van Puyenbroek MJE, Ter Laak HJ, Gabreës-Festen AAWM.  Neuromuscular complications in patients given Pavulon (pancuronium bromide) during artificial ventilation. Clin Neurol Neurosurg . 1985;;87:17-22.
11 +
Williams AC, Sturman S, Kelsey S, Curran FT, Finnegan JA.  The neuropathy of the critically ill. BMJ . 1986;;293:790-791.
12 +
Lycklama à Nijholt J, Troost J.  Critical illness polyneuropathy.  In: Matthews WB, ed. Handbook of Clinical Neurology: Neuropathies . Amsterdam, the Netherlands: Elsevier Science Publishers; 1987;; 7:575-585.
13 +
Barat M, Brochet B, Vital C, Mazaux JM, Arné L.  Polyneuropathies au cours de séjours prolongés en réanimation. Rev Neurol . 1987;;143:823-831.
14 +
Coronel B, Mercatello A, Couturier JC, et al.  Polyneuropathy: potential cause of difficult weaning. Crit Care Med . 1990;;18:486-489.
15 +
Lopez Messa JB, García A.  Acute polyneuropathy in critically ill patients. Intensive Care Med . 1990;;16:159-162.
16 +
Gorson KC, Ropper AH.  Acute respiratory failure neuropathy: a variant of critical illness polyneuropathy. Crit Care Med . 1993;;21:267-271.
17 +
Leijten FSS, De Weerd AW.  Critical illness polyneuropathy: a review of the literature, definition, and pathophysiology. Clin Neurol Neurosurg . 1994;;96:10-19.
18 +
Witt NJ, Zochodne DW, Bolton CF, et al.  Peripheral nerve function in sepsis and multiple organ failure. Chest . 1991;;99:176-184.
19 +
Spitzer AR, Giancarlo T, Maher L, Awerbuch G, Bowles A.  Neuromuscular causes of prolonged ventilator dependency. Muscle Nerve . 1992;;15:682-686.
20 +
Coakley JH, Nagendran K, Honavar M, Hinds CJ.  Preliminary observations on the neuromuscular abnormalities in patients with organ failure and sepsis. Intensive Care Med . 1993;;19:323-328.
21 +
Sprung CL.  Definitions of spesis—have we reached a consensus? Crit Care Med . 1991;;19:849-851.
22 +
Lemaire F.  Difficult weaning. Intensive Care Med . 1993;;19( (suppl) ):S69-S73.
23 +
Op de Coul AAW, Verheul GAM, Leijten ACM, Schellens RLLA, Teepen JLJM.  Critical illness polyneuromyopathy after artificial respiration. Clin Neurol Neurosurg . 1991;;93:27-33.
24 +
Seiser A, Schwarz S, Brainin M.  Critical illness polyneuropathie: Klinik und Langzeitergebnisse. Wien Klin Wochenschr . 1992;;104:294-300.
25 +
Bone RC, Balk RA, Cerra FB, et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest . 1992;; 101:1644-1655.
26 +
Goris RJA, te Boekhorst TPA, Nuytinck JKS, Gimbrère JSF.  Multiple-organ failure: generalized autodestructive inflammation? Arch Surg . 1985;;120: 1109-1115.
27 +
Asbury AK, Cornblath DR.  Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol . 1990;;27( (suppl) ):S21-S24.
28 +
Medical Research Council. Aids to the Investigation of the Peripheral Nervous System . London, England: Her Majesty's Stationary Office; 1976;.
29 +
Knaus WA, Draper EA, Wagner DP, Zimmerman JE.  APACHE II: a severity of disease classification system. Crit Care Med . 1985;;13:818-829.
30 +
Dodson BA, Kelly BJ, Braswell LM, Cohen NH.  Changes in acetylcholine receptor number in muscle from critically ill patients receiving muscle relaxants. Crit Care Med . 1995;;23:815-821.

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