Preliminary observations on the neuromuscular abnormalities in patients with organ failure and sepsis.

Abstract

To estimate the incidence and nature of neuromuscular abnormalities in a representative group of ITU patients. Prospective sequential study. Teaching hospital ITU. 23 patients who eventually stayed > 7 days on ITU who had no contraindication to muscle biopsy and whose relatives gave informed consent. Muscle histopathology, neurophysiological studies, record of all drugs administered, APACHE II score, organ system failure score, presence or absence of sepsis, clinical evaluation of neuromuscular problems, time to hospital discharge. Heterogeneous neuromuscular abnormalities were present in 22 out of 23 patients studied and included axonal neuropathy, denervation, generalised fibre atrophy, non-specific myopathy and necrotising myopathy. Neuromuscular abnormalities are almost invariable in longstay intensive care patients and the resulting weakness may seriously delay hospital discharge. Various abnormalities were seen but no obvious aetiological factors were identified. The origin of the abnormalities is probably multifactorial.