Preliminary observations on the neuromuscular abnormalities in patients with organ failure and sepsis.

OBJECTIVE

To estimate the incidence and nature of neuromuscular abnormalities in a representative group of ITU patients.

DESIGN

Prospective sequential study.

SETTING

Teaching hospital ITU.

PATIENTS

23 patients who eventually stayed > 7 days on ITU who had no contraindication to muscle biopsy and whose relatives gave informed consent.

MEASUREMENTS AND RESULTS

Muscle histopathology, neurophysiological studies, record of all drugs administered, APACHE II score, organ system failure score, presence or absence of sepsis, clinical evaluation of neuromuscular problems, time to hospital discharge. Heterogeneous neuromuscular abnormalities were present in 22 out of 23 patients studied and included axonal neuropathy, denervation, generalised fibre atrophy, non-specific myopathy and necrotising myopathy.

CONCLUSION

Neuromuscular abnormalities are almost invariable in longstay intensive care patients and the resulting weakness may seriously delay hospital discharge. Various abnormalities were seen but no obvious aetiological factors were identified. The origin of the abnormalities is probably multifactorial.