Cargando…

Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study

INTRODUCTION: Critical illness myopathy and/or neuropathy (CRIMYNE) is frequent in intensive care unit (ICU) patients. Although complete electrophysiological tests of peripheral nerves and muscles are essential to diagnose it, they are time-consuming, precluding extensive use in daily ICU practice....

Descripción completa

Detalles Bibliográficos
Autores principales: Latronico, Nicola, Bertolini, Guido, Guarneri, Bruno, Botteri, Marco, Peli, Elena, Andreoletti, Serena, Bera, Paola, Luciani, Davide, Nardella, Anna, Vittorielli, Elena, Simini, Bruno, Candiani, Andrea
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2151880/
https://www.ncbi.nlm.nih.gov/pubmed/17254336
http://dx.doi.org/10.1186/cc5671
_version_ 1782144780015239168
author Latronico, Nicola
Bertolini, Guido
Guarneri, Bruno
Botteri, Marco
Peli, Elena
Andreoletti, Serena
Bera, Paola
Luciani, Davide
Nardella, Anna
Vittorielli, Elena
Simini, Bruno
Candiani, Andrea
author_facet Latronico, Nicola
Bertolini, Guido
Guarneri, Bruno
Botteri, Marco
Peli, Elena
Andreoletti, Serena
Bera, Paola
Luciani, Davide
Nardella, Anna
Vittorielli, Elena
Simini, Bruno
Candiani, Andrea
author_sort Latronico, Nicola
collection PubMed
description INTRODUCTION: Critical illness myopathy and/or neuropathy (CRIMYNE) is frequent in intensive care unit (ICU) patients. Although complete electrophysiological tests of peripheral nerves and muscles are essential to diagnose it, they are time-consuming, precluding extensive use in daily ICU practice. We evaluated whether a simplified electrophysiological investigation of only two nerves could be used as an alternative to complete electrophysiological tests. METHODS: In this prospective, multi-centre study, 92 ICU patients were subjected to unilateral daily measurements of the action potential amplitude of the sural and peroneal nerves (compound muscle action potential [CMAP]). After the first ten days, complete electrophysiological investigations were carried out weekly until ICU discharge or death. At hospital discharge, complete neurological and electrophysiological investigations were performed. RESULTS: Electrophysiological signs of CRIMYNE occurred in 28 patients (30.4%, 95% confidence interval [CI] 21.9% to 40.4%). A unilateral peroneal CMAP reduction of more than two standard deviations of normal value showed the best combination of sensitivity (100%) and specificity (67%) in diagnosing CRIMYNE. All patients developed the electrophysiological signs of CRIMYNE within 13 days of ICU admission. Median time from ICU admission to CRIMYNE was six days (95% CI five to nine days). In 10 patients, the amplitude of the nerve action potential dropped progressively over a median of 3.0 days, and in 18 patients it dropped abruptly within 24 hours. Multi-organ failure occurred in 21 patients (22.8%, 95% CI 15.4% to 32.4%) and was strongly associated with CRIMYNE (odds ratio 4.58, 95% CI 1.64 to 12.81). Six patients with CRIMYNE died: three in the ICU and three after ICU discharge. Hospital mortality was similar in patients with and without CRIMYNE (21.4% and 17.2%; p = 0.771). At ICU discharge, electrophysiological signs of CRIMYNE persisted in 18 (64.3%) of 28 patients. At hospital discharge, diagnoses in the 15 survivors were critical illness myopathy (CIM) in six cases, critical illness polyneuropathy (CIP) in four, combined CIP and CIM in three, and undetermined in two. CONCLUSION: A peroneal CMAP reduction below two standard deviations of normal value accurately identifies patients with CRIMYNE. These should have full neurological and neurophysiological evaluations before discharge from the acute hospital.
format Text
id pubmed-2151880
institution National Center for Biotechnology Information
language English
publishDate 2007
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-21518802007-12-25 Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study Latronico, Nicola Bertolini, Guido Guarneri, Bruno Botteri, Marco Peli, Elena Andreoletti, Serena Bera, Paola Luciani, Davide Nardella, Anna Vittorielli, Elena Simini, Bruno Candiani, Andrea Crit Care Research INTRODUCTION: Critical illness myopathy and/or neuropathy (CRIMYNE) is frequent in intensive care unit (ICU) patients. Although complete electrophysiological tests of peripheral nerves and muscles are essential to diagnose it, they are time-consuming, precluding extensive use in daily ICU practice. We evaluated whether a simplified electrophysiological investigation of only two nerves could be used as an alternative to complete electrophysiological tests. METHODS: In this prospective, multi-centre study, 92 ICU patients were subjected to unilateral daily measurements of the action potential amplitude of the sural and peroneal nerves (compound muscle action potential [CMAP]). After the first ten days, complete electrophysiological investigations were carried out weekly until ICU discharge or death. At hospital discharge, complete neurological and electrophysiological investigations were performed. RESULTS: Electrophysiological signs of CRIMYNE occurred in 28 patients (30.4%, 95% confidence interval [CI] 21.9% to 40.4%). A unilateral peroneal CMAP reduction of more than two standard deviations of normal value showed the best combination of sensitivity (100%) and specificity (67%) in diagnosing CRIMYNE. All patients developed the electrophysiological signs of CRIMYNE within 13 days of ICU admission. Median time from ICU admission to CRIMYNE was six days (95% CI five to nine days). In 10 patients, the amplitude of the nerve action potential dropped progressively over a median of 3.0 days, and in 18 patients it dropped abruptly within 24 hours. Multi-organ failure occurred in 21 patients (22.8%, 95% CI 15.4% to 32.4%) and was strongly associated with CRIMYNE (odds ratio 4.58, 95% CI 1.64 to 12.81). Six patients with CRIMYNE died: three in the ICU and three after ICU discharge. Hospital mortality was similar in patients with and without CRIMYNE (21.4% and 17.2%; p = 0.771). At ICU discharge, electrophysiological signs of CRIMYNE persisted in 18 (64.3%) of 28 patients. At hospital discharge, diagnoses in the 15 survivors were critical illness myopathy (CIM) in six cases, critical illness polyneuropathy (CIP) in four, combined CIP and CIM in three, and undetermined in two. CONCLUSION: A peroneal CMAP reduction below two standard deviations of normal value accurately identifies patients with CRIMYNE. These should have full neurological and neurophysiological evaluations before discharge from the acute hospital. BioMed Central 2007 2007-01-25 /pmc/articles/PMC2151880/ /pubmed/17254336 http://dx.doi.org/10.1186/cc5671 Text en Copyright © 2007 Latronico et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Latronico, Nicola
Bertolini, Guido
Guarneri, Bruno
Botteri, Marco
Peli, Elena
Andreoletti, Serena
Bera, Paola
Luciani, Davide
Nardella, Anna
Vittorielli, Elena
Simini, Bruno
Candiani, Andrea
Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study
title Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study
title_full Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study
title_fullStr Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study
title_full_unstemmed Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study
title_short Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study
title_sort simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the italian multi-centre crimyne study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2151880/
https://www.ncbi.nlm.nih.gov/pubmed/17254336
http://dx.doi.org/10.1186/cc5671
work_keys_str_mv AT latroniconicola simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT bertoliniguido simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT guarneribruno simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT botterimarco simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT pelielena simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT andreolettiserena simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT berapaola simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT lucianidavide simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT nardellaanna simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT vittoriellielena simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT siminibruno simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy
AT candianiandrea simplifiedelectrophysiologicalevaluationofperipheralnervesincriticallyillpatientstheitalianmulticentrecrimynestudy