Faculty of Medicine, Menoufia University Hospitals, Shebin El-Kom, Egypt.
Eur J Neurol. 2018 Jul;25(7):991-e76. doi: 10.1111/ene.13649. Epub 2018 Apr 30.
Critical illness polyneuropathy and myopathy (CIP/CIM) is being increasingly recognized as a significant clinical problem in critically ill children especially if they have spent long periods in the intensive care unit. So the aim was to determine the frequency of CIP/CIM amongst mechanically ventilated children and to analyse the associated risk factors and drawbacks frequently encountered in this cohort.
The study included 105 patients admitted to the paediatric intensive care unit who underwent mechanical ventilation for ≥7 days. These patients were screened daily for awakening. Patients with severe muscle weakness on day 7 post-awakening underwent nerve conduction studies and electromyography. Accordingly, the patients were classified as CIP/CIM patients if they had abnormal neurophysiology studies or control patients if normal neurophysiology studies were obtained. Their clinical and laboratory profiles had been recorded as well.
Overall, of 105 patients who achieved satisfactory awakening, 34 patients (32.4%) developed CIP/CIM mostly of the axonal polyneuropathy pattern (27.6%) whilst 71 control patients (67.6%) showed normal electrophysiological studies. The mean duration of mechanical ventilation was significantly longer in patients with CIP/CIM compared to control patients (P = 0.001). The study also revealed that 62.1% of our CIP/CIM patients failed weaning trials and finally died. CIP/CIM was significantly associated with decreased platelets, elevated liver enzymes and prolonged prothrombin time. Acidosis, low serum calcium and albumin levels and higher blood glucose were also found to be more significant in CIP/CIM patients compared to control patients.
Critically ill children frequently develop CIP/CIM, mostly of axonal polyneuropathy pattern, which compromises rehabilitation and recovery and is associated with a number of comorbidities.
危重病性多发性神经病和肌病（CIP/CIM）在重症监护病房的儿童中越来越被认为是一个重要的临床问题，尤其是如果他们在重症监护病房中度过了很长时间。因此，本研究旨在确定机械通气儿童中 CIP/CIM 的发生率，并分析该队列中经常遇到的相关危险因素和并发症。
本研究纳入了 105 名因机械通气而入住儿科重症监护病房且通气时间≥7 天的患者。这些患者每天都进行觉醒筛查。如果在觉醒后第 7 天出现严重肌无力，患者则进行神经传导研究和肌电图检查。因此，如果神经生理学检查异常，则将患者归类为 CIP/CIM 患者；如果获得正常神经生理学检查结果，则归类为对照组患者。此外，还记录了患者的临床和实验室特征。
在 105 名达到满意觉醒的患者中，34 名（32.4%）患者出现 CIP/CIM，其中大多数为轴索性多发性神经病（27.6%），而 71 名对照组患者（67.6%）的神经电生理检查正常。与对照组患者相比，CIP/CIM 患者的机械通气时间明显更长（P=0.001）。此外，研究还发现，62.1%的 CIP/CIM 患者脱机试验失败，最终死亡。CIP/CIM 与血小板减少、肝酶升高和凝血酶原时间延长显著相关。与对照组患者相比，CIP/CIM 患者还存在酸中毒、低血清钙和白蛋白水平以及更高的血糖。
危重症儿童常发生 CIP/CIM，主要表现为轴索性多发性神经病，这会影响康复和恢复，并与多种合并症相关。
