Critical Illness Weakness, Polyneuropathy and Myopathy: Diagnosis, treatment, and long-term outcomes

Table 1 Generalized neuromuscular conditions associated with critical illness.

Condition	Incidence	Clinical features	Electrophysiologic findings	Serum creatine kinase	Muscle biopsy	Prognosis
POLYNEUROPATHY Critical illness polyneuropathy	Common	Flaccid limbs; respiratory weakness	Axonal degeneration of motor and sensory fibres	Nearly normal	Denervation atrophy	Variable
NEUROMUSCULAR TRANSMISSION DEFECT Transient neuromuscular blockade	Common with neuromuscular blocking agents	Flaccid limbs; respiratory weakness	Abnormal repetitive nerve stimulation studies	Normal	Normal	Good
CRITICAL ILLNESS MYOPATHY Thick-filament myopathy	Common with steroids, neuromuscular blocking agents, and sepsis	Flaccid limbs; respiratory weakness	Abnormal spontaneous activity	Mildly elevated	Loss of thick (myosin) filaments	Good
Acute myopathy with scattered necrosis	Common	Flaccid limbs; respiratory weakness	Myopathy	Mildly or moderately elevated	Scattered necrosis	Variable
Acute myopathy with diffuse necrosis (necrotising myopathy of intensive care)	Rare	Flaccid weakness; myoglobinuria	Severe myopathy	Markedly elevated, myoglobinuria	Marked necrosis	Poor
Disuse (cachectic) myopathy	Common	Muscle wasting	Normal	Normal	Normal or type II fibre atrophy	Variable
RHABDOMYOLYSIS	Rare	Flaccid limbs	Near normal	Markedly elevated (myoglobinuria)	Normal or mild necrosis	Good
COMBINED POLYNEUROPATHY AND MYOPATHY	Common	Flaccid limbs; respiratory weakness	Indicate combined polyneuropathy and myopathy	Variable	Denervation atrophy and myopathy	Variable

ISSN: 1364-8535