Polyneuropathy and myopathy of critical illness

Kritična bolest je svako životno ugrožavajuće stanje bez čije bi farmakološke i/ili mehaničke potpore vitalnim organima nastupio smrtni ishod. Liječi se u Jedinicama intenzivnog liječenja (JIL). Vrlo česta komplikacija liječenja je mišićna slabost stečena u JIL-u, pri čemu se izdvajaju dva entiteta: miopatija kritične bolesti (CIM) i polineuropatija kritične bolesti (CIP), tj. sindrom njihovog preklapanja – polimioneuropatija kritične bolesti (CIPNM). Klinički se očituju simetričnom mišićnom slabošću, izraženije proksimalne muskulature, a na njih se posumnja prilikom neuspjeha odvajanja pacijenata od mehaničke ventilacije. Prema podacima iz literature, do 62% pacijenata kod kojih dođe do neuspjeha odvajanja od mehaničke ventilacije, ima neki oblik neuromuskularne bolesti. Različiti su patofiziološki mehanizmi u pozadini, od oksidativnog stresa, mitohondrijalne disfunkcije do promjena u mikrocirkulaciji uzrokovanih sistemskim upalnim zbivanjima. Rizični čimbenici navedenih stanja su sindrom sistemnog upalnog odgovora (SIRS, eng. systemic inflammatory response syndrome), sepsa, hiperglikemija, hipoalbuminemija, upotreba vazopresora i neurmoskulatornih blokatora. Dijagnoza se postavlja kombinacijom kliničkih značajki i nalazima elektrofizioloških testiranja. Liječenje se zasniva na liječenju osnovne bolesti, sprječavanju komplikacija i ranoj rehabilitaciji. Postoje podaci o učinkovitosti električne mišićne stimulacije (EMS) u liječenju i prevenciji mišićne slabosti stečene u JIL-u. Kod jedne četvrtine pacijenata prilikom otpusta iz bolnice zaostaje neki od stupnjeva mišićne slabosti ili osjetnih ispada.Critical illness is any life-threatening condition wich would, without appropriate pharmacological and/or mechanical support to vital organs, lead to death. It is treated in the Intensive Care Unit (ICU). A very common complication of treatment is muscle weakness acquired in the ICU, whereby two entities are distinguished: critical illness myopathy (CIM) and critical illness polyneuropathy (CIP), and their overlapping syndrome – critical illness polymyoneuropathy (CIPNM). Clinically, they are manifested by symmetrical muscle weakness, more pronounced in the proximal musculature, and they are suspected when patients fail to be weaned from mechanical ventilation. According to data from the literature, up to 62% of patients who fail to be weaned from the mechanical ventilation have some form of neuromuscular disease. There are various pathophysiological mechanisms in the background, from oxidative stress, mitochondrial dysfunction to changes in microcirculation caused by systemic inflammatory events. Risk factors for the aforementioned conditions are systemic inflammatory response syndrome (SIRS), sepsis, hyperglycemia, hypoalbuminemia, use of vasopressors, steroids, and neuromuscular blockers. The diagnosis is established by a combination of clinical features and the findings of electrophysiological testing. Treatment is based on treatment of the underlying disease, prevention of complications and early rehabilitation. There are data on the effectiveness of electrical muscle stimulation (EMS) in the treatment and prevention of muscle weakness acquired in the ICU. One quarter of patients have some degree of residual muscle weakness or loss of sensation when they are discharged from the hospital