Intensive Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
SODc Neurofisiopatologia, DAI Neuro-muscolo-scheletrico e organi di senso, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Acta Neurol Scand. 2020 Dec;142(6):574-584. doi: 10.1111/ane.13324. Epub 2020 Aug 31.
Critical illness polyneuropathy and myopathy (CIPNM) frequently affects critical patients and can occur after severe acquired brain injuries (sABI) influencing the functional recovery. We aimed to assess how the concomitance between CIPNM and sABI might influence the rehabilitative outcomes in terms of functional autonomy, oral feeding recovery and endotracheal tube weaning.
Adult patients with sABI admitted to an intensive rehabilitation unit and underwent an electromyography examination within seven days after admission were included. Assessed rehabilitative outcomes at discharge were decannulation success and its timing, functional autonomy measured by the Functional Independence Measure (FIM) and the Glasgow outcome scale expanded (GOS-E) and oral feeding recovery assessed by the Functional Oral Intake Scale (FOIS) score.
Among the 224 included patients (81 (36%) females, age (median[IQR]): 68.73[21.66] years), 119 (53.1%) presented CIPNM at admission. Albeit the change of rehabilitative outcomes between admission and discharge was significant in all the sABI patients (P < .001 for ΔFOIS, ΔFIM and ΔGOS-E), those with a concomitant CIPNM achieved significantly lower scores as evaluated by Mann-Whitney tests (P < .001 for ΔFIM Δ and GOS-E; P < .005 for ΔFOIS). The CIPNM absence was associated with a higher probability to achieve functional autonomy (GOS-E > 4) (OR:4.57 (1.49/14.06); P < .01) and oral feeding recovery (FOIS ≥ 4) (OR:2.07 (1.07/3.99); P = .03) at discharge. CIPNM presence did not influence decannulation success but a longer time to cannula weaning was required (P < .01 in the log-rank test).
CIPMN significantly affects the rehabilitative outcomes after a sABI and should be taken into account for better rehabilitative handling.
危重病性多发性神经病和肌病（CIPNM）常影响危重病患者，并且可能在严重获得性脑损伤（sABI）后发生，从而影响功能恢复。我们旨在评估 CIPNM 与 sABI 的共存如何影响功能自主性、口腔喂养恢复和气管拔管的康复结果。
纳入入住重症康复病房且入院后 7 天内行肌电图检查的成年 sABI 患者。出院时评估康复结果为拔管成功率及其时间、功能独立性测量（FIM）和格拉斯哥结局扩展量表（GOS-E）评估的功能自主性以及功能性口腔摄入量表（FOIS）评分评估的口腔喂养恢复情况。
在 224 例纳入患者中（81 例（36%）为女性，年龄（中位数[IQR]）：68.73[21.66]岁），119 例（53.1%）入院时存在 CIPNM。尽管所有 sABI 患者入院和出院时的康复结果变化均有统计学意义（所有 P<0.001，ΔFOIS、ΔFIM 和 ΔGOS-E），但 Mann-Whitney 检验评估的伴有 CIPNM 的患者得分明显较低（所有 P<0.001，ΔFIM Δ和 GOS-E；所有 P<0.005，ΔFOIS）。CIPNM 缺失与更高的获得功能自主性（GOS-E>4）（OR：4.57（1.49/14.06））和口腔喂养恢复（FOIS≥4）（OR：2.07（1.07/3.99））的可能性相关（P<0.01）。CIPNM 存在并不影响拔管成功率，但需要更长的时间才能进行气管拔管（对数秩检验 P<0.01）。
CIPMN 显著影响 sABI 后的康复结果，应在康复处理中加以考虑。
