Critical Illness Polyneuropathy in Children with Infectious Diseases

Authors

  • V.B. Voitenkov Pediatric Research and Clinical Center for Infectious Diseases, Saint-Petersburg, Russia, 197022, Saint-Petersburg, Russia
  • A.V. Klimkin Pediatric Research and Clinical Center for Infectious Diseases, Saint-Petersburg, Russia, 197022, Saint-Petersburg, Russia
  • N.V. Skripchenko Pediatric Research and Clinical Center for Infectious Diseases, Saint-Petersburg, Russia, 197022, Saint-Petersburg, Russia
  • A.A. Vilnits Pediatric Research and Clinical Center for Infectious Diseases, Saint-Petersburg, Russia, 197022, Saint-Petersburg, Russia

DOI:

https://doi.org/10.31907/2310-9394.2019.07.2

Keywords:

Critical illness, critical illness polyneuropathy, children, electromyography.

Abstract

Our goal was to establish electrophysiological features of critical illness polyneuropathy in children with infectious diseases.

Materials and Methods: We evaluated peripheral nervous system involvement in 67 critically ill children, admitted in ICU with different types of infectious diseases (viral encephalitis, meningoencephalitis, meningitis, acute gastroenteritis). Age of the group varied from 4 months to 17 years. All patients underwent conduction studies and neurological investigation. Sensory and motor fibers of n. ulnaris et n. medianus, motor fibers of n. Tibialis and sensory fibers of n. Suralis were tested. Lowering of the amplitudes, conduction velocity slowing and asymmetry were accounted for the motor and sensory fibers.

Results: In 47 cases (n=71) diagnosis of critical illness polyneuropathy (CIP) was established. Lesions mostly involved lower limbs nerves. According to our data, severe course of CIP was seen in 40% of all cases. Average time of CIP onset in children was 5-7 days from the beginning of mechanical ventilation.

Conclusions: Critical illness polyneuropathy in children with infectious diseases is a severe condition which may lead to the disability of the patients. Average time of its onset is the 5-7 days from the beginning of the mechanical ventilation in 71% of the patients. More often sensory and motor fibers of lower limbs nerves are affected. Conduction studies is a valuable tool in diagnostic process in establishing the critical illness polyneuropathy in children with infectious diseases.

References

Ydemann M, Eddelien HS, Lauritsen AØ. Treatment of critical illness polyneuropathy and/or myopathy - a systematic review. Dan Med J 2012; 59(10): 45-51.

Schweickert WD, Hall J. ICU-acquired weakness. Chest 2007; 131: 1541-1549. https://doi.org/10.1378/chest.06-2065

Chen HY, Chen HC, Lin MC, Liaw MY. Bilateral Diaphragmatic Paralysis in a Patient With Critical Illness Polyneuropathy: A Case Report. Medicine (Baltimore) 2015; 94(31): e1288. https://doi.org/10.1097/MD.0000000000001288

Lefaucheur JP, Nordine T, Rodriguez P. Origin of ICU acquired paresis determined by direct muscle stimulation. J Neurol Neurosurg Psychiatry 2006; 77(5): 500-506. https://doi.org/10.1136/jnnp.2005.070813

Ricks E. Critical illness polyneuropathy and myopathy: a review of evidence and the implications for weaning from mechanical ventilation and rehabilitation. Physiotherapia 2007; (93): 151-156. https://doi.org/10.1016/j.physio.2006.09.005

Ryan CS, Conlee EM, Sharma R, Sorenson EJ, Boon AJ, Laughlin RS. Nerve conduction normal values for electrodiagnosis in pediatric patients. Muscle Nerve 2019; 60(2): 155-160. https://doi.org/10.1002/mus.26499

Madrazo-Osuna J. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med 2005; 3: 349-354. https://doi.org/10.1097/01.CCM.0000153521.41848.7E

Coakley JH, Nagendran GD. Yarwood. Patterns of neurophysiological abnormality in prolonged critical illness. Intensive Care Med 1998; 24: 801-807. https://doi.org/10.1007/s001340050669

Williams S, Horrocks IA, Ouvrier RA, et al. Critical illness polyneuropathy and myopathy in pediatric intensive care: a review. Pediatr Crit Care Med 2007; 8: 18-22. https://doi.org/10.1097/01.pcc.0000256623.01254.40

Thabet Mahmoud A, Tawfik MAM, Abd El Naby SA, Abo El Fotoh WMM, Saleh NY, Abd El Hady NMS. Neurophysiological study of critical illness polyneuropathy and myopathy in mechanically ventilated children; additional aspects in paediatric critical illness comorbidities. Eur J Neurol 2018; 25(7): 991-e76. https://doi.org/10.1111/ene.13649

Shubham S, Dhochak N, Singh A, Patel SK, Chakrabarty B, Sankar J, Gulati S, Kabra SK, Jaryal AK, Lodha R. Polyneuropathy in Critically Ill Mechanically Ventilated Children: Experience From a Tertiary Care Hospital in North India. Pediatr Crit Care Med 2019; 20(9): 826-831. https://doi.org/10.1097/PCC.0000000000002012

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Published

2019-12-25

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