Evaluation of pediatric critical illness neuropathy/myopathy in pediatric intensive care unit

Abstract

Background : Serial electrophysiological evaluation in adults admitted to Intensive Care Unit (ICU) has shown an incidence of Critical Illness Myopathy and Polyneuropathy as 30% (CRIMYNE STUDY). There is no prospective serial electrophysiology based study in children admitted to ICU. Methods : Trial Registry Number: NCT02763709 A prospective cohort study of all children (2-12 years) admitted to PICU with Pediatric Risk of Mortality (PRISM) of > 20 for more than 24 hours was conducted in PGIMER, Chandigarh from January 2016 to December 2016. A complete electrophysiological evaluation (4 motor nerves and 2 sensory nerves) was performed at baseline. Children with preexisting or current neuromuscular disorder were excluded. Following the entry evaluation, daily simplified electrophysiological testing of unilateral sural nerve and common peroneal nerve was assessed. A 25% decrease in Sensory Nerve Action Potential and Compound Muscle Action Potential from baseline was considered as significant reduction suggestive of PED CIMP and was followed by complete electrophysiological reassessment for confirmation. Results : During the study period, of the total 481 children assessed for eligibility, 97 were enrolled. The median age of the cohort was 7 years. Sepsis (81%); Vasoactive support (43%); Multiorgan dysfunction (26%) were the common risk factors. Of the 433 eligible patient ICU days, 380 electrophysiological observations were done with a median duration of nerve conduction study of 3 days. A significant reduction of greater than twenty-five percent in CMAP of common peroneal nerve was not detected in any of the 380 observations. However, a solitary case who did not fit the inclusion criteria was diagnosed with PED CIMP during the study period. Conclusion : Unlike adults, children admitted in ICU with PRISM>20 have a very low incidence of PED CIMP by serial electrophysiological evaluation.