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critical illness polyneuropathy
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:
1) distal limb weakness
2) minimal sensory symptoms
3) no autonomic symptoms
4) not associated with cognitive impairment
5) reduced to absent DTR
6) dysphagia is common [3]
Special laboratory:
- 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
- see critical illness weakness
- pureed diet generally adequate for patients with dysphagia
- dysphagia generally resolves within 30 days, independent of presence of tracheostomy tube [3]
General
critical illness weakness; critical illness neuromyopathy
polyneuropathy
References
- 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: 19160304
- 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: 25377021
- Chawla J, Gruener G.
Management of critical illness polyneuropathy and myopathy.
Neurol Clin. 2010 Nov;28(4):961-77.
PMID: 20816273