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Muscle weakness in critically ill children

From the Departments of Pediatrics (Neurology [Drs. Banwell and Vajsar], Critical Care Medicine [Drs. Mildner and Shemie, A.C. Hassal], and Neuropathology [Dr. Becker]), Hospital for Sick Children, Toronto, Ontario, Canada.

Address correspondence to Dr. B.L. Banwell, Department of Pediatrics (Neurology), Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8; e-mail: brenda.banwell{at}sickkids.ca

Objective: To establish the incidence of muscle weakness in critically ill children.

Methods: Neuromuscular examinations were performed in 830 children without identified antecedent or acute neuromuscular disease (age 3 months to 17 years 11 months) admitted for >24 hours to a pediatric intensive care unit (ICU) over a 1-year period.

Results: Fourteen of 830 (1.7%) patients had generalized weakness. Four failed repeated attempts to extubate. Multiple organ dysfunction occurred in 11 patients and sepsis in 9. Most children received corticosteroids, neuromuscular blocking agents, or aminoglycoside antibiotics. Eight of the 14 children were solid organ or bone marrow transplant recipients. Muscle biopsy showed evidence of acute quadriplegic myopathy in all three patients in whom biopsy was performed. Three patients died. In survivors, significant weakness persisted for 3 to 12 months following ICU discharge.

Conclusions: Muscle weakness is an infrequent but significant feature of critical illness in children. Transplant recipients seem to be at particular risk.

Received November 26, 2002. Accepted in final form September 5, 2003.

Drs. Banwell and Mildner contributed equally to this work.

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