NEUROLOGICAL COMPLICATIONS OF SEVERE ILLNESS AND PROLONGED MECHANICALVENTILATION

Objective. To test the hypothesis that prolonged motor recovery after long-term ventilation may be due to polyneuropathy and can be foreseen at an early stage by electromyography (EMG). Design. Cohort study wit h an entry period of 18 months. Polyneuropathy was identified by EMG s tudies in the intensive care unit (ICU). During a 1-year follow-up, am ount of time war recorded to reach a rehabilitation end point. Setting . The general ICU of a community hospital. Patients. Fifty patients yo unger than 75 years who were receiving mechanical ventilation for more than 7 days. Main outcome measures. A rehabilitation end point was de fined as return of normal muscle strength and ability to walk 50m inde pendently Results. In 29 of 50 patients, an EMG diagnosis of polyneuro pathy was made in the ICU. Patients with polyneuropathy had a higher m ortality in the ICU (14 vs 4; P=0.03), probably related to multiple or gan failure (22 vs 11; P=0.08) or aminoglycoside treatment of suspecte d gram-negative sepsis (17 vs 4; P=0.05). Rehabilitation was more prol onged in IZ patients with polyneuropathy than in 12 without polyneurop athy (P=0.001). Of nine patients with delays beyond 4 weeks, eight had polyneuropathy, five of whom had persistent motor handicap after 1 ye ar. In particular, axonal polyneuropathy with conduction slowing on EM C indicated a poor prognosis. Conclusions. Polyneuropathy in the criti cally ill is related to multiple organ failure and gram-negative sepsi s, is associated with higher mortality, and causes important rehabilit ation problems. EMC recordings in the ICU can identify patients at ris k.