Fss. Leijten et al., THE ROLE OF POLYNEUROPATHY IN MOTOR CONVALESCENCE AFTER PROLONGED MECHANICAL VENTILATION, JAMA, the journal of the American Medical Association, 274(15), 1995, pp. 1221-1225
Objective.-To test the hypothesis that prolonged motor recovery after
longterm ventilation may be due to polyneuropathy and can be foreseen
at an early stage by electromyography (EMG). Design.-Cohort study with
an entry period of 18 months. Polyneuropathy was identified by EMG st
udies in the intensive care unit (ICU). During a 1-year followup, amou
nt of time was recorded to reach a rehabilitation end point. Setting.-
The general ICU of a community hospital. Patients.-Fifty patients youn
ger than 75 years who were receiving mechanical ventilation for more t
han 7 days. Main Outcome Measures.-A rehabilitation end point was defi
ned as return of normal muscle strength and ability to walk 50 m indep
endently. 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=.03), probably related to multiple org
an failure (22 vs 11; P=.08) oraminoglycoside treatment of suspected g
ram-negative sepsis (17 vs 4; P=.05). Rehabilitation was more prolonge
d in 12 patients with polyneuropathy than in 12 without polyneuropathy
(P=.001). Of nine patients with delays beyond 4 weeks, eight had poly
neuropathy, five of whom had persistent motor handicap after 1 year. I
n particular, axonal polyneuropathy with conduction slowing on EMG ind
icated a poor prognosis. Conclusions.-Polyneuropathy in the critically
ill is related to multiple organ failure and gram-negative sepsis, is
associated with higher mortality, and causes important rehabilitation
problems. EMG recordings in the ICU can identify patients at risk.