Subject(s)
Head Movements , Movement Disorders/diagnosis , Neuromuscular Diseases/diagnosis , Aged , Diagnosis, Differential , Female , Head Movements/physiology , Humans , Male , Movement Disorders/etiology , Muscle Weakness/diagnosis , Muscle Weakness/etiology , Myasthenia Gravis/complications , Myasthenia Gravis/diagnosis , Neck Muscles , Neuromuscular Diseases/etiology , SyndromeABSTRACT
Two patients with chronic pulmonary disease, a woman of 38 and a man of 54 years old, who had developed a status asthmaticus, had difficulties being weaned from artificial ventilation. They suffered from an acute myopathy caused by a combination of high-dose corticosteroids and muscle relaxants (pancuronium, vecuronium). This acute myopathy is characterised by generalised flaccid quadriplegia with muscle atrophy and areflexia, difficulties being weaned from artificial ventilation, myoglobinuria and high levels of creatine kinase activity in serum. The prognosis is good; almost complete recovery occurs. Muscle biopsy may reveal necrotising myopathy and occasionally, selective loss of thick myofilaments.
Subject(s)
Muscular Atrophy/etiology , Status Asthmaticus/complications , Status Asthmaticus/therapy , Adult , Female , Humans , Male , Middle Aged , Muscles/pathology , Muscular Atrophy/chemically induced , Muscular Atrophy/pathology , Neuromuscular Nondepolarizing Agents/adverse effects , Quadriplegia/chemically induced , Ventilator WeaningABSTRACT
Critical illness polyneuromyopathy (CIPN) occurs in critically ill patients on artificial respiration. The pathophysiology of this disease is unknown. Because of the strong association with sepsis, the levels of cytokines, TNF and IL-6 were measured several times daily in patients having CIPN and in a control group of critically ill patients without CIPN. The diagnosis of CIPN was made on clinical criteria. Patients with CIPN had no significantly elevated levels of TNF or IL-6 as compared to controls.
Subject(s)
Critical Care , Interleukin-6/blood , Polymyositis/physiopathology , Polyneuropathies/physiopathology , Respiration, Artificial , Tumor Necrosis Factor-alpha/metabolism , Adolescent , Adult , Aged , Critical Illness , Cytokines/physiology , Female , Humans , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Organ Failure/physiopathology , Muscular Atrophy/etiology , Muscular Atrophy/physiopathology , Polymyositis/etiology , Polyneuropathies/etiology , Ventilator WeaningSubject(s)
Neuromuscular Diseases/physiopathology , Acute Disease , Asthma/therapy , Humans , Myosins/physiology , Neuromuscular Agents/adverse effects , Neuromuscular Blocking Agents/adverse effects , Neuromuscular Diseases/etiology , Respiration, Artificial/adverse effects , Sepsis/complications , Steroids/adverse effectsABSTRACT
Up to now, 71 critically ill patients have been reported with neuromuscular complications after artificial respiration. The authors review the literature and present data of a personal series of 22 patients all suffering from severe flaccid tetraparesis and muscle atrophy, which developed after an average of two weeks artificial respiration. The prognosis was relatively good in those surviving the primary disease. The multiconditional causes are discussed with emphasis on the combination of polyneuropathy and myopathy. Tumor necrosis factor (TNF), a key mediator of sepsis, which also has an influence on muscle and nerves, is mentioned as a possible cause of this illness.
Subject(s)
Neuromuscular Diseases/etiology , Respiration, Artificial/adverse effects , Adult , Aged , Atrophy , Critical Care , Electrophysiology , Female , Humans , Male , Middle Aged , Muscles/pathology , Neuromuscular Diseases/pathology , Neuromuscular Diseases/physiopathology , Quadriplegia/etiology , SyndromeABSTRACT
Critical illness polyneuropathy is a syndrome of neuromuscular complications after artificial respiration. The authors present the data of their own 22 patients all suffering from severe flaccid tetraparesis, areflexia and muscle atrophy, after an average of two weeks on artificial respiration. The prognosis is relatively favourable. The multi-conditional causes are discussed with emphasis on the combination of polyneuropathy and myopathy. The role of plasma factors such as cachectin, which is identical to tumour necrosis factor (TNF), is described. Attention is drawn to this important illness which occurs especially in patients in the intensive care unit with problems in the weaning from artificial respiration.
