CRITICAL ILLNESS MYOPATHY AND NEUROPATHY

Background Critically ill patients may develop muscle weakness or para lysis during the course of sepsis and multiple-organ failure. We studi ed peripheral nerve and muscle disorders (NMD) in comatose patients. M ethods Comatose patients who developed paralysis associated with absen t deep-tendon reflexes had electroneuromyography (ENMG) and muscle-ner ve biopsy specimens taken. Onset and duration of sepsis, multiple-orga n dysfunction and failure, biochemical alterations, and drugs potentia lly interfering with nerve-muscle function were recorded. Findings 24 patients became quadriparetic or quadriplegic; muscle changes were fou nd in 23. Axonal neuropathy was found in eight of 22 patients examined . All patients had prolonged sepsis and multiple-organ dysfunction, bu t only 14 had multiple-organ failure. Drugs such as steroids, neuromus cular-blocking agents, and aminoglycosides were not responsible for pa resis, and the part played by hyperglycaemia and hypoalbuminaemia is u ncertain. Attending physicians predicted a fatal outcome in all cases, although six of seven survivors fully recovered within 115-210 days f rom the onset of paralysis. Interpretation Comatose patients may becom e completely paralysed because of NMD. The diagnosis is important to a void unnecessary investigations and unreasonably pessimistic prognosis . ENMG is essential for the diagnosis and for planning further clinica l management. Biopsy needs to be done only when it is necessary to pro perly classify NMD.