From the Guidelines
Neuropathy of critical illness should be managed with early mobilization, motor training, and nutrition/dysphagia management, as these interventions have been shown to improve outcomes in patients with post-intensive care syndrome. This condition is a neurological complication that develops in severely ill patients, particularly those in intensive care units, and presents as muscle weakness and sensory deficits that typically affect the limbs symmetrically, with more pronounced symptoms in the legs than arms. According to the most recent guideline on multimodal rehabilitation for patients with post-intensive care syndrome 1, early rehabilitation approaches, as well as long-term access to specialized rehabilitation centers, are recommended.
The diagnosis of neuropathy of critical illness involves clinical examination, nerve conduction studies, and electromyography to differentiate it from other causes of weakness. Management primarily focuses on treating the underlying critical illness, maintaining proper nutrition, controlling blood glucose levels, and early physical therapy. Medications specifically for this neuropathy are limited, but gabapentin or pregabalin may help manage neuropathic pain if present. The pathophysiology involves axonal degeneration related to microvascular changes, metabolic alterations, and inflammatory mediators that damage peripheral nerves.
Some key points to consider in the management of neuropathy of critical illness include:
- Early mobilization and rehabilitation are crucial for improving outcomes, as they help prevent muscle atrophy and maintain joint mobility while the nerves recover 1.
- Regular and repeated assessments of the physical, cognitive, and psychological health in patients at risk for or having post-intensive care syndrome are necessary 1.
- Delirium prophylaxis focuses on behavioral interventions, and ICU diaries can prevent or treat psychological health issues like anxiety and post-traumatic stress disorders 1.
- Therapy options include additional physical rehabilitation interventions, which can be tailored to the individual patient's needs 1.
Overall, the management of neuropathy of critical illness requires a multidisciplinary approach that addresses the patient's physical, cognitive, and psychological health, with a focus on early mobilization, rehabilitation, and prevention of complications.
From the Research
Definition and Causes of Neuropathy of Critical Illness
- Neuropathy of critical illness, also known as critical illness polyneuropathy (CIP) and critical illness myopathy, is a condition that occurs in patients who are critically ill, causing weakness and muscle atrophy 2.
- The exact pathogenesis of CIP and critical illness myopathy is not fully understood, but it is thought to be related to the inflammatory response and multiple organ failure that occurs in critically ill patients 2.
- Risk factors for developing neuropathy of critical illness include sepsis, bed rest, and the use of certain medications such as steroids and neuromuscular blocking agents 3, 4, 2.
Diagnosis and Treatment of Neuropathy of Critical Illness
- Diagnosis of neuropathy of critical illness can be challenging, but it can be made using a combination of clinical examination, electrophysiological testing, and muscle biopsy 2, 5, 6.
- Treatment of neuropathy of critical illness is primarily focused on stabilizing the underlying critical condition and eliminating sepsis 2.
- Early mobilization and rehabilitation have been shown to be beneficial in preventing and mitigating the sequelae of bed rest and improving patient outcomes 3, 4, 5, 6.
- Glycemic control and judicious use of steroids and neuromuscular blocking agents are also important in reducing the incidence and severity of neuropathy of critical illness 4, 5.
Long-term Outcomes and Management of Neuropathy of Critical Illness
- Neuropathy of critical illness can have long-term physical, cognitive, and mental impairments, emphasizing the need for a multidisciplinary model of care 6.
- Follow-up clinics for patients surviving critical illness can provide direct clinical support, manage referrals to other specialists, and serve as a platform for research to describe the natural history of post-intensive care syndrome and identify new therapeutic interventions 6.
- Early ICU mobilization combined with evidence-based ICU practices can effectively reduce short-term weakness, and multi-professional collaborations are needed to guarantee a multi-dimensional evaluation and unitary community care programs for survivors of critical illnesses 6.