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Electrophysiology of neuromuscular disorders in critical illness
Author(s) -
Lacomis David
Publication year - 2013
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.23615
Subject(s) - critical illness polyneuropathy , intensive care unit , medicine , myopathy , weakness , physical medicine and rehabilitation , compound muscle action potential , polyneuropathy , neuromuscular blocking agents , muscle weakness , intensive care medicine , electrophysiology , critically ill , critical illness , anesthesia , surgery
Neuromuscular disorders, predominantly critical illness myopathy (CIM) and critical illness polyneuropathy (CIP) occur in approximately one‐third of patients in intensive care units. The aim of this study was to review the important role of electrophysiology in this setting. Results In CIM, sarcolemmal inexcitability causes low amplitude compound muscle action potentials (CMAPs) that may have prolonged durations. Needle electrode examination usually reveals early recruitment of short duration motor unit potentials, often with fibrillation potentials. In CIP, the findings are usually those of a generalized axonal sensorimotor polyneuropathy. Direct muscle stimulation aids in differentiating CIP and CIM and in identifying mixed disorders along with other electrodiagnostic and histopathologic studies. Identifying evolving reductions in fibular CMAP amplitudes in intensive care unit (ICU) patients predicts development of neuromuscular weakness. Conclusions Knowledge of the various neuromuscular disorders in critically ill patients, their risk factors, and associated electrodiagnostic findings can lead to development of a rational approach to diagnosis of the cause of neuromuscular weakness in ICU patients. Muscle Nerve 47: 452–463, 2013