Diaphragmatic denervation in intensive care unit patients

• Published in: Electromyography and clinical neurophysiology Vol. 39; no. 1; p. 3
• Main Authors: Sander, H W, Saadeh, P B, Chandswang, N, Greenbaum, D, Chokroverty, S
• Format: Journal Article
• Language: English
• Published: Belgium 01.01.1999
• Subjects: Action Potentials - physiology; Axons - physiology; Cardiac Surgical Procedures - adverse effects; Critical Care; Critical Illness; Diaphragm - physiopathology; Electromyography - instrumentation; Electromyography - methods; Esophageal Neoplasms - complications; Humans; Laryngeal Neoplasms - complications; Median Nerve - physiopathology; Mediastinal Diseases - complications; Motor Neurons - physiology; Multiple Organ Failure - complications; Needles; Neural Conduction - physiology; Neuromuscular Diseases - etiology; Neurons, Afferent - physiology; Peripheral Nervous System Diseases - etiology; Respiration, Artificial; Respiratory Paralysis - etiology; Sepsis - complications; Spinal Cord Injuries - complications; Tibial Nerve - physiopathology; Ulnar Nerve - physiopathology; Ventilator Weaning
• ISSN: 0301-150X

The causes of prolonged requirement for mechanical ventilation in the intensive care unit (ICU) are currently a subject of investigation. Critical illness polyneuropathy (CIP), an axonal polyneuropathy that frequently occurs with prolonged sepsis and multi-organ failure, has been cited as a frequent cause of difficulty with weaning from a ventilator. The relative contribution of diaphragmatic denervation in ICU patients with and without CIP has not been definitively determined. We reviewed 102 ventilator dependent intensive care unit (ICU) patients. Critical illness polyneuropathy (CIP) was diagnosed based upon electrodiagnostic criteria. Electrodiagnostic studies included diaphragmatic needle electromyography (EMG) to evaluate for diaphragmatic denervation. The medical charts of the patients with diaphragmatic denervation were reviewed for etiologies other than CIP for the diaphragmatic denervation. Our results suggest: 1) Respiratory impairment in ICU patients may often be unrelated to either CIP or diaphragmatic denervation; 2) Only about half of ventilator dependent CIP patients have diaphragmatic denervation; 3) Diaphragmatic denervation in ICU patients frequently may be attributable to causes other than CIP.