PRELIMINARY-OBSERVATIONS ON THE NEUROMUSCULAR ABNORMALITIES IN PATIENTS WITH ORGAN FAILURE AND SEPSIS

Objective: To estimate the incidence and nature of neuromuscular abnor malities in a representative group of ITU patients. Design: Prospectiv e sequential study. Setting: Teaching hospital ITU. Patients: 23 patie nts who eventually stayed > 7 days on ITU who had no contraindication to muscle biopsy and whose relatives gave informed consent. Measuremen ts and results: Muscle histopathology, neurophysiological studies, rec ord of all drugs administered, APACHE II score, organ system failure s core, presence or absence of sepsis, clinical evaluation of neuromuscu lar problems, time to hospital discharge. Heterogeneous neuromuscular abnormalities were present in 22 out of 23 patients studied and includ ed axonal neuropathy, denervation, generalised fibre atrophy, non-spec ific myopathy and necrotising myopathy. Conclusion: Neuromuscular abno rmalities are almost invariable in longstay intensive care patients an d the resulting weakness may seriously delay hospital discharge. Vario us abnormalities were seen but no obvious aetiological factors were id entified. The origin of the abnormalities is probably multifactorial.