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Early development of critical illness myopathy and neuropathy in patients with severe sepsis

From the Departments of Neurology (J.K., T.B.H.) and Medicine (M.M.); Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, and Department of Neuroscience, Cell Biology, and Physiology (M.M.R.), Wright State University, Dayton, OH.

Address correspondence and reprint requests to Dr. J. Khan, Department of Neurology, Grady Memorial Hospital, 80 Jesse Hill Junior Drive, Atlanta, GA 30303; e-mail: jkhan{at}emory.edu

Objectives: To characterize the prevalence, time of onset, and cause of neuromuscular dysfunction in patients with severe sepsis.

Methods: We conducted a prospective cohort study in which participants with severe sepsis underwent weekly neurologic examinations and nerve conduction studies (NCSs) within 72 hours of developing severe sepsis until intensive care unit (ICU) discharge. Electromyography was preformed if clinical weakness developed or if there was a significant reduction in nerve conduction response amplitudes.

Results: Abnormal NCS were present upon enrollment in 63% of patients (31/48). The presence of abnormal baseline NCS was predictive of hospital mortality (55% vs 0% for patients with normal baseline NCS; p < 0.001). Development of acquired neuromuscular dysfunction could be predicted by NCS done on day 7. Twenty patients remained in the ICU long enough to have serial NCSs; 50% of these patients developed acquired neuromuscular dysfunction. Most patients with acquired neuromuscular dysfunction had electrophysiologic evidence of both critical illness myopathy and critical illness neuropathy.

Conclusion: Changes in nerve conduction studies occur in the majority of patients early in the course of severe sepsis and predict the development of acquired neuromuscular dysfunction and mortality in intensive care unit patients. Most patients with acquired neuromuscular dysfunction after sepsis have both critical illness myopathy and critical illness neuropathy.

Disclosure: The authors report no conflicts of interest.

Received March 9, 2006. Accepted in final form June 13, 2006.

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