Critical Illness Polyneuropathy and Myopathy and Clinical Detection of the Recovery of Consciousness in Severe Acquired Brain Injury Patients with Disorders of Consciousness after Rehabilitation.

Bahia Hakiki,Francesca Cecchi,Silvia Pancani,Maenia Scarpino,Antonello Grippo,Raisa Sterpu,Claudio Macchi,Anna Romoli,Andrea Mannini,Francesca Draghi

doi:10.3390/diagnostics12020516

Abstract

Background: Disorders of consciousness (DoCs) include unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS). Critical illness polyneuropathy and myopathy (CIPNM) is frequent in severe acquired brain injuries and impacts functional outcomes at discharge from the intensive rehabilitation unit (IRU). We investigated the prevalence of CIPNM in DoCs and its relationship with the consciousness assessment. Methods: Patients with DoCs were retrospectively selected from the database including patients admitted to the IRU of the IRCCS Don Gnocchi Foundation, Florence, from August 2012 to May 2020. Electroneurography/electromyography was performed at admission. Consciousness was assessed using the Coma Recovery Scale-Revised (CRS-R) at admission and discharge. Patients transitioning from a lower consciousness state to a higher one were classified as improved responsiveness (IR). Results: A total of 177 patients were included (UWS: 81 (45.8%); MCS: 96 (54.2%); 78 (44.1%) women; 67 years (IQR: 20). At admission, 108 (61.0%) patients had CIPNM. At discharge, 117 (66.1%) patients presented an IR. In the multivariate analysis, CRS-R at admission (p = 0.006; OR: 1.462) and CIPNM (p = 0.039; OR: −1.252) remained significantly associated with IR only for the UWS patients. Conclusions: CIPNM is frequent in DoCs and needs to be considered during the clinical consciousness assessment, especially in patients with UWS.

Highlights

Introduction iationsIn recent decades, important advances have been made in emergency medicine and neurosurgical procedures, leading to improved survival of victims of severe acquired brain injuries
We aimed to investigate the prevalence of Critical illness polyneuropathy and myopathy (CIPNM) only in patients with severe acquired brain injuries admitted with DoC in the intensive rehabilitation unit (IRU)
It can be hypothesized that a CIPNM diagnosis is a marker of a higher clinical severity that hinders consciousness recovery independent from the Coma Recovery Scale-Revised (CRS-R) score at admission [20]. t was shown that critical illness polyneuropathy, myopathy, or both most commonly develop after acute respiratory distress syndrome, sepsis, systemic inflammatory response syndrome, or multiple organ failure, and that prolonged bed rest, medication, and infections are major risk factors for CIPNM; other major risk factors include long duration of organ dysfunction, parenteral nutrition, vasopressor and catecholamine support, and central neurologic failure [27], all of which may affect the probability of recovery of consciousness [28]

Summary

Introduction

Introduction iationsIn recent decades, important advances have been made in emergency medicine and neurosurgical procedures, leading to improved survival of victims of severe acquired brain injuries. Patients may progress to a clinical condition of disorders of consciousness (DoC), which includes unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergent from the MCS (E-MCS) [1]. These diagnostic categories are defined by the presence and nature (reflex in UWS vs intentional in MCS) of behavioral responses to multisensorial stimuli. Disorders of consciousness (DoCs) include unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS). Consciousness was assessed using the Coma Recovery Scale-Revised (CRSR) at admission and discharge.

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