A SYNDROME OF ACUTE SEVERE MUSCLE NECROSIS IN INTENSIVE-CARE UNIT PATIENTS

Four septic patients and one asthmatic patient are described who devel oped a severe paralytic disorder in an intensive care unit (ICU), asso ciated with a rise in serum creatine kinase and a severe necrotizing m yopathy. All cases had received non-depolarizing muscle blocking agent s and large intravenous doses of glucocorticoids. Three patients devel oped myoglobinuria. No improvement or very little improvement in muscl e function was noted in the four fatal cases. The single survivor reco vered his strength after 6 months. This syndrome (''necrotizing myopat hy of intensive care'') provides one of the differential diagnoses for ICU-acquired weakness. The myopathy appears to have several interdepe ndent causes and it is proposed that these should be classified as myo necrosis ''priming'' factors (glucocorticoids, myotropic infections, s epsis) and ''triggering'' factors (non-depolarizing muscle blocking ag ents).