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Determinants of critical illness polyneuropathy in the case of long-term ICU treatment
Critical Care volume 13, Article number: P109 (2009)
Neuromuscular weakness is a condition which is often found during long-term ICU treatment. Critical illness polyneuropathy (CIP) is the main reason for neuromuscular weakness. Diagnosis of CIP is difficult in the ICU setting. The reasons, even predisposing factors, for CIP are not fully studied. The aim of this study was to analyze whether sedation, duration of ventilation, and duration of ICU stay are good determinants of CIP.
A prospective investigation of patients treated in the ICU for longer than 7 days during a 6-month period (1 May 2008 to 31 October 2008) was made. All ICU survivors were included in the study. The APACHE II scores, first ICU day SOFA scores, duration of sedation, amount of sedation, and duration of ventilation were calculated. Electroneuromyography was performed for every patient. Data of patients with (CIP group) and without (control group) CIP were compared.
Thirty-seven patients were included in the study. In 16 cases CIP was diagnosed (43.2% of patients). The was no age difference in both groups of patients (55.37 ± 16.5 years in CIP group; 51.86 ± 17.92 in control group; P = 0.55). The APACHE II score in the CIP group was high in comparison with the control group – 20.31 ± 7 vs. 15.8 ± 5.89 (P = 0.04). The CIP group admission-day SOFA score was higher in comparison with the control group – 7.87 ± 4.05 vs. 5.09 ± 2.52 (P = 0.01). Duration of ICU stay was 20.37 ± 15.54 days in the CIP group and 15.19 ± 10.95 in the control group (P = 0.24). Duration of sedation in the CIP group was 118.68 ± 219.59 hours and in the control group was 78.9 ± 94.22 hours (P = 0.45). The sedation volume in the CIP group was 5,386.8 ± 18,112.04 mg and in the control group was 892.25 ± 1,440.97 mg (P = 0.26). There was no difference in duration of ventilation in both groups (330.62 ± 376.28 hours in CIP group and 159.92 ± 273.27 hours in control group; P = 0.11).
CIP is often a complication of long-term ICU treatment (43.2% in our ICU). Correlation exists between the APACHE II score, admission-day SOFA score and development of CIP in cases of long (>7 days) ICU treatment according to our results. No correlation between duration of sedation and ventilation, volume of sedation, duration of ICU treatment and development of CIP was found. Larger studies are needed to establish the determinants of CIP.
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Klimasauskas, A., Sereike, I., Kekstas, G. et al. Determinants of critical illness polyneuropathy in the case of long-term ICU treatment. Crit Care 13, P109 (2009). https://doi.org/10.1186/cc7273
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