Critical Illness Polyneuropathy in Patients With Major Burn Injuries

Objective: Critical illness polyneuropathy in burn patients is an underreported condition. It is associated with high mortality rates and prolonged hospital stay and rehabilitation. This study aims to further define the cause and outcome of critical illness polyneuropathy following major burn injuries. Methods: A retrospective review of all burn patients with neuropathy that presented to Royal North Shore Hospital, Sydney, between the period of 2004 and 2009 was performed. The neurological findings, diagnostic processes, and outcomes were examined. End points such as duration on the ventilator, length of intensive care, and hospital stay were recorded. Results: There were 7 patients in total that exhibited abnormal neurological findings. Ages ranged from 17 to 43 years with all injuries sustained in flame burns. Mean total burnt surface area is 46%. There was no mortality in this series but all 7 had evidence of sepsis and multiorgan failure with an average 42 days spent on the ventilator. Clinical findings varied greatly. Five had involvement of nerves away from the site of burns. Upper-limb weakness tended to have a slower recovery. Examination and neurophysiologic studies were often hampered by pain and bandaging over burnt skin. Conclusions: Neurological manifestations of critical illness polyneuropathy are varied and cannot always be explained by direct thermal or compression injury. This study confirms a strong link to sepsis, multiple organ failure, and slow ventilatory wean. The requirement for a precise neurophysiological diagnosis of critical illness polyneuropathy needs to be balanced with technical considerations and the likelihood of alternative diagnoses.