The clinical course of acute quadruplegia of the critically ill

Aim of the study

To describe the clinical course of acute quadruplegia of intensive care.

Setting

Ten bed medical ICU in university hospital Hradec Králové.

Patients

Twelve consecutive patients with acute quadruplegia that occured during critical illness.

Studyperiod

Fifteen months.

Design

Prospective observational study.

Methods

For precise diagnosis of the neuromuscular disorder, clinical, biochemical, electrophysiological examinations and skeletal muscle biopsies were performed. During the whole stay in the hospital, skeletal muscle strength was clinically examined and quantified by a standard six grade scale (no movement: 0, palpable contraction: 1, movement with help: 2, spontaneous movement against gravity: 3, reduced muscle strength: 4, full stength: 5). Length of stay in the ICU and in the hospital, the duration of mechanical ventilation and need of tracheostomy were recorded. None of the patients recieved any neuromuscular blocking agents or corticosteroids.

Results

Out of the 12 patients, 4 had to be excluded due to concommitant focal cerebral laesion impairing motor functions. Two patients had to be referred to another hospital and thus were lost for the study. In the remaining six patients, a combination of axonal sensory-motor polyneuropathy in electrophysiology and myopathy in histological specimen was found. The mortality in these patients was 50% (3 of 6). The complete muscle strength examination was performed in three survivors. The clinical course of these patients is summarized in the Table.

Table

Conclusions

Neuromuscular failure during critical illness is a serious medical and economical problem. All the surviving patients with acute quadruplegia of intensive care recieved mechanical ventilation for more than 3 months, requiring a very long stay in the ICU and a prolonged rehabilitation. On discharge, peroneal paresis was present in all survivors. In our ICU, more than one bed is permanently occupied by patients with severe neuromuscular failure. These neuromuscular disorders developed in patients who were not treated with neuromuscular blocking agents or corticosteroids.

Supported by grant IGA No. NB 5197-3.