Original Articles
17 February 2025
Vol. 41 No. 1 (2019)
Critical Illness Polyneuropathy: a multicenter study on functional outcome
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
30
Views
24
Downloads
Authors
Objective. To describe the functional recovery of consecutive inpatients with Critical Illness Polyneuropathy (CIP) at the time-point of the discharge from rehabilitation units according to Barthel Index scores. To examine whether age, gender, pre-ICU admission diagnosis, tracheostomy performance, heterotopic ossification development and duration of neuro-rehabilitation treatment are among the prognostic factors that can predict the functional outcome in studied patients.
Design. A retrospective observational clinical study from January 2010 to December 2014. Three rehabilitation units in Greece.
Results. Sixteen subjects (57.1%) had >60 Bl discharge scores, showing a prospect in gaining further independence. Females presented a tendency for better functional outcome vs males (73.8±12.6 vs 58.6±23.4, p=0.082). Respiratory, septic and neurologic patients demonstrated better rates of functional improvement after the rehabilitation process vs cardiac patients (p<0.001, p=0.009 and p=0.019, respectively vs p=0,072). Heterotopic ossification development proved to be an adverse independent prognostic factor of functional outcome (47.8 ≤ 25.7 vs 68.8 ≤ 17.7, p=0.023).
Conclusions. A proportion of included patients experienced severe disability with poor prospect of further functional development and return to work at the discharge from the rehabilitation units. According to the present study, which is the first that focuses only on CIP and its outcome, specific prognostic factors can be defined. Our results can be used as pilot data for larger studies, so that firmer conclusions can be drawn.
Altmetrics
Downloads
Download data is not yet available.
Citations
1) Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ. Polyneuropathy in critically ill patients. Journal of neurology, neurosurgery, and psychiatry 1984 Nov; 47(11): 1223-31. DOI: https://doi.org/10.1136/jnnp.47.11.1223
2) Bolton CF, Laverty DA, Brown JD, Witt NJ, Hahn AF, Sibbald WJ. Critically ill polyneuropathy: electrophysiological studies and differentiation from Guillain-Barre syndrome. Journal of neurology, neurosurgery, and psychiatry 1986; 49(5): 563-73. DOI: https://doi.org/10.1136/jnnp.49.5.563
3) Witt NJ, Zochodne DW, Bolton CF, Grand'Maison F, Wells G, Young GB, et al. Peripheral nerve function in sepsis and multiple organ failure. Chest 1991; 99(1): 176-84. DOI: https://doi.org/10.1378/chest.99.1.176
4) van Mook WN, Hulsewe-Evers RP. Critical illness polyneuropathy. Current opinion in critical care 2002; 8(4): 302-10. DOI: https://doi.org/10.1097/00075198-200208000-00006
5) Jubran A. Critical illness and mechanical ventilation: effects on the diaphragm. Respiratory care 2006; 51(9): 1054-64.
6) Berek K, Margreiter J, Willeit J. Polyneuropathy in the critically ill patient-critical illness polyneuropathy. [Die Polyneuropathie des kritisch kranken Patienten-critical illness polyneuropathy]. Wiener klinische Wochenschrift 1998; 110(7): 243-52.
7) Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G. Clinical review: Critical illness polyneuropathy and myopathy. Critical care 2008; 12(6): 238. DOI: https://doi.org/10.1186/cc7100
8) Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive care medicine 2007; 33(11): 1876-91. DOI: https://doi.org/10.1007/s00134-007-0772-2
9) Khan J, Harrison TB, Rich MM. Mechanisms of neuromuscular dysfunction in critical illness. Critical care clinics 2008; 24(1): 165-77. 10) Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. The New England journal of medicine 2014; 370(17): 1626-35. DOI: https://doi.org/10.1016/j.ccc.2007.10.004
11) Ydemann M, Eddelien HS, Lauritsen AO. Treatment of critical illness polyneuropathy and/or myopathy - a systematic review. Danish medical journal 2012; 59(10): A4511.
12) Mehrholz J, Pohl M, Kugler J, Burridge J, Muckel S, Elsner B. Physical rehabilitation for critical illness myopathy and neuropathy. An abridged version of Cochrane Systematic Review. European journal of physical and rehabilitation medicine 2015; 51(5): 655-61. 13) Herridge MS. Long-term outcomes after critical illness: past, present, future. Current opinion in critical care 2007 Oct; 13(5): 473-5. 14) Pati S, Goodfellow JA, Iyadurai S, Hilton-Jones D. Approach to critical illness polyneuropathy and myopathy. Postgraduate medical journal 2008; 84(993): 354-60. DOI: https://doi.org/10.1136/pgmj.2007.064915
15) Herridge MS. Long-term outcomes after critical illness. Current opinion in critical care 2002 Aug; 8(4): 331-6. DOI: https://doi.org/10.1097/00075198-200208000-00010
16) Guarneri B, Bertolini G, Latronico N. Long-term outcome in patients with critical illness myopathy or neuropathy: the Italian multicentre CRIMYNE study. Journal of neurology, neurosurgery, and psychiatry 2008; 79(7): 838-41. DOI: https://doi.org/10.1136/jnnp.2007.142430
17) Intiso D, Amoruso L, Zarrelli M, Pazienza L, Basciani M, Grimaldi G, et al. Long-term functional outcome and health status of patients with critical illness polyneuromyopathy. Acta neurologica Scandinavica 2011; 123(3): 211-9. DOI: https://doi.org/10.1111/j.1600-0404.2010.01414.x
18) Koch S, Wollersheim T, Bierbrauer J, Haas K, Morgeli R, Deja M, et al. Long-term recovery In critical illness myopathy is complete, contrary to polyneuropathy. Muscle & nerve 2014; 50(3): 431-6. 19) Semmler A, Okulla T, Kaiser M, Seifert B, Heneka MT. Long-term neuromuscular sequelae of critical illness. Journal of neurology 2013; 260(1): 151-7. DOI: https://doi.org/10.1002/mus.24175
20) van der Schaaf M, Beelen A, de Vos R. Functional outcome in patients with critical illness polyneuropathy. Disability and rehabilitation 2004 Oct 21; 26(20): 1189-97. DOI: https://doi.org/10.1080/09638280410001724861
21) Oddone E, Imbriani M. [Are we underestimating occupational risks for neurodegenerative diseases?]. G Ital Med Lav Ergon 2015; 37(1): 5-7. 22) Fundarò C, Casale R. Rehabilitation and dementia in the era of elderly workers. G Ital Med Lav Ergon 2012; 34(2): 197-201. 23) Compston A. Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. His Majesty's Stationery Office: 1942; pp. 48 (iri) and 74 figures and 7 diagrams; with aids to the examination of the peripheral nervous system. By Michael O'Brien for the Guarantors of Brain. Saunders Elsevier: 2010; pp. [8] 64 and 94 Figures. Brain: a journal of neurology 2010 Oct; 133(10): 2838-44. DOI: https://doi.org/10.1093/brain/awq270
24) De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. Jama 2002; 288(22): 2859-67. DOI: https://doi.org/10.1001/jama.288.22.2859
25) Hough CL, Lieu BK, Caldwell ES. Manual muscle strength testing of critically ill patients: feasibility and interobserver agreement. Critical care 2011; 15(1): R43. DOI: https://doi.org/10.1186/cc10005
26) Tian-Shin Y, Chueh-Hung W, Wen-Shian C, Tyng-Guey W. Serial ultrasonography for early detection and follow-up of heterotopic ossification in stroke. Journal of Medical Ultrasound 2012; 20: 119-24. DOI: https://doi.org/10.1016/j.jmu.2012.04.009
27. Mavrogenis AF, Soucacos PN, Papagelopoulos PJ. Heterotopic ossification revisited. Orthopedics 2011; 34: 177. DOI: https://doi.org/10.3928/01477447-20110124-08
28) Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Maryland state medical journal 1965; 14: 61-5. DOI: https://doi.org/10.1037/t02366-000
29) Z'Graggen WJ, Lin CS, Howard RS, Beale RJ, Bostock H. Nerve excitability changes in critical illness polyneuropathy. Brain: a journal of neurology 2006; 129(Pt 9): 2461-70. DOI: https://doi.org/10.1093/brain/awl191
30) Fan E. Critical illness neuromyopathy and the role of physical therapy and rehabilitation in critically ill patients. Respiratory care 2012; 57(6): 933-46. DOI: https://doi.org/10.4187/respcare.01634
31. Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med 2007; 35(1): 139-45. DOI: https://doi.org/10.1097/01.CCM.0000251130.69568.87
32) Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 2009; 37(9): 2499-505. DOI: https://doi.org/10.1097/CCM.0b013e3181a38937
33. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008; 36(8): 2238-43. 34) Latronico N, Guarneri B. Critical illness myopathy and neuropathy. Minerva anestesiologica 2008; 74(6): 319-23. DOI: https://doi.org/10.1097/CCM.0b013e318180b90e
35) Latronico N, Shehu I, Seghelini E. Neuromuscular sequelae of critical illness. Current opinion in critical care 2005 Aug; 11(4): 381-90. 36) Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE. Stroke rehabilitation: analysis of repeated Barthel index measures. Archives of physical medicine and rehabilitation 1979; 60(1): 14-7. DOI: https://doi.org/10.1097/01.ccx.0000168530.30702.3e
37) El-Menyar AA. Pathophysiology and hemodynamic of postresuscitation syndrome. Saudi medical journal 2006; 27(4): 441-5.
38) Guo Y, Collaco CR, Bruera E. Heterotopic ossification in critical illness and cancer: a report of 2 cases. Archives of physical medicine and rehabilitation 2002; 83(6): 855-9. DOI: https://doi.org/10.1053/apmr.2002.32440
39) Jacobs JW, De Sonnaville PB, Hulsmans HM, van Rinsum AC, Bijlsma JW. Polyarticular heterotopic ossification complicating critical illness. Rheumatology 1999; 38(11): 1145-9. DOI: https://doi.org/10.1093/rheumatology/38.11.1145
40) Clements NC, Jr., Camilli AE. Heterotopic ossification complicating critical illness. Chest 1993; 104(5): 1526-8. DOI: https://doi.org/10.1378/chest.104.5.1526
41) Loisel P, Durand MJ, Berthelette D, Vezina N, Bari R, Gagnon D, et al. Disability prevention: new paradigm for the management of occupational back pain. Dis Manag Health Outcomes 2001; 9(7): 351-60. DOI: https://doi.org/10.2165/00115677-200109070-00001
42) Feuerstein M. A multidisciplinary approach to the prevention, evaluation, and management of work disability. J Occup Rehabil 1991; 1(1): 5-12. DOI: https://doi.org/10.1007/BF01073276
43) Aasdahl L, Pape K, Jensen C, Vasseljen O, Braathen T, Johnsen R, Fimland MS. Associations Between the Readiness for Return to Work Scale and Return to Work: A Prospective Study. J Occup Rehabil. doi: 10.1007/s10926-017-9705-2. DOI: https://doi.org/10.1007/s10926-017-9705-2
How to Cite
Critical Illness Polyneuropathy: a multicenter study on functional outcome. (2025). Giornale Italiano Di Medicina Del Lavoro Ed Ergonomia, 41(1), 58-64. https://doi.org/10.4081/gimle.492
Copyright (c) 2019 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.