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Treatment of critical illness polyneuropathy and/or myopathy -- a systematic review |
Ydemann M, Eddelien HS, Lauritsen AO |
Danish Medical Journal 2012 Oct;59(10):A4511 |
systematic review |
INTRODUCTION: The objective was to search the literature with a view to providing a general description of critical illness myopathy/polyneuropathy (CIM/CIP), including its genesis and prevention. Furthermore, it was our aim to determine whether new treatments have occurred in the past five years. MATERIAL AND METHODS: PubMed, CINAHL and Swedmed+ were searched using the terms CIM, CIP and intensive care. The search was narrowed by adding the limits: humans, English, Danish, Norwegian, Swedish and, furthermore, articles had to have been published in the past five years as we aimed to focus on new knowledge. RESULTS: A total of 74 articles were found. We excluded articles focusing on children and intensive care, tight insulin therapy in patients without CIM/CIP and articles focusing on Guillain-Barre syndrome, triage, bleeding, alcohol or meningitis. Of the remaining 36 articles, only five focused on CIM/CIP treatment. Their relevant original references were found and used too. CONCLUSION: CIM/CIP is the most commonly occurring intensive care unit (ICU)-acquired neuromuscular dysfunction, and it is associated with a significant increase in length of stay, delayed weaning from mechanical ventilation, prolonged rehabilitation and, consequently, more expenses. To treat/prevent this condition, it seems reasonable to ensure maximal functional status for survivors of an ICU-stay by applying a multimodal therapeutic approach that includes intensive insulin therapy, minimal sedation and, as suggested by new evidence, early physiotherapy and electrical muscle stimulation.
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