Abstract
BackgroundCritical illness polyneuropathy (CIP) is a complex disease affecting 30–70% of critically ill patients.MethodsClinical (Barthel index, length of stay (LOS), morbidity, duration of mechanical ventilation, routine lab results) and neurophysiological (neurography) data of 191 patients admitted to neurological early rehabilitation and diagnosed with CIP have been analyzed retrospectively.ResultsCIP diagnosis was correct in 159 cases (83%). In this study, systemic inflammation, sepsis, systemic inflammatory response syndrome (SIRS), multiple organic failure (MOF), chronic renal failure, liver dysfunction, mechanical ventilation, diabetes, dyslipidemia and impaired ion homeostasis (hypocalcaemia, hypokalemia) were associated with CIP. Neurography, in particular of the peroneal, sural, tibial and median nerves, helped to identify CIP patients. Compound muscle action potential amplitude (r = −0.324, p < 0.05), as well as sensory (r = −0.389, p < 0.05) and motor conduction velocity (r = −0.347, p < 0.05) of the median nerve correlated with LOS in neurological early rehabilitation but not with outcome measures.ConclusionsIn most cases, diagnosis of CIP among neurological early rehabilitation patients seems to be correct. Neurography may help to verify the diagnosis and to learn more about CIP pathophysiology, but it does not allow outcome prediction. Further studies on CIP are strongly encouraged.
Highlights
Critical illness polyneuropathy (CIP) is a complex disease affecting 30–70% of critically ill patients
The present study focused on clinical features and outcome of CIP patients admitted to neurological early rehabilitation
Initial lab results as well as patient clinical complexity level (PCCL), duration of mechanical ventilation, Barthel index (BI), length of stay (LOS), co-diagnoses and colonization with multi-drug resistant germs were included in the analysis. Colonization with these bacteria is of importance because it has been demonstrated that it deteriorates outcome from neurological early rehabilitation [13, 14]
Summary
Critical illness polyneuropathy (CIP) is a complex disease affecting 30–70% of critically ill patients. Among critically ill neurological or neurosurgical patients entering early rehabilitation, critical illness polyneuropathy (CIP) and/or myopathy (CIM) are frequent disorders. It has been shown that CIP affects 30–70% of critical care patients [1]. CIP is regarded as a predominantly distal, motor and sensory axonal polyneuropathy [1] and may contribute to a failure of weaning from mechanical ventilation, higher mortality and prolonged length of stay (LOS) in hospital and rehabilitation [2,3,4]. CIP prevalence in early rehabilitation is higher than in acute-care facilities because critical care patients after failure of weaning accumulate in rehabilitation centers [5, 6]. Some risk factors have been identified, such as systemic inflammatory response syndrome (SIRS), sepsis, multiple organ failure (MOF), age, gender, mechanical ventilation, morbidity, renal failure, hypotension, hyperosmolarity, parenteral nutrition, low serum albumin, immobilization, medication and hypoxia [2, 7,8,9]
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