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Neuromuscular Function in Survivors of the Acute Respiratory Distress Syndrome

Published online by Cambridge University Press:  02 December 2014

Michael J. Angel ,
Vera Bril ,
Patrick Shannon  and
Margaret S. Herridge
Michael J. Angel
Affiliation:
Department of Medicine, Division of Neurology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Vera Bril
Affiliation:
Department of Medicine, Division of Neurology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Patrick Shannon
Affiliation:
Department of Pathology, Division of Neuropathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
Margaret S. Herridge
Affiliation:
Department of Medicine, Divisions of Respiratory and Critical Care Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Abstract

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Background:

Survivors of acute respiratory distress syndrome (ARDS) report generalized weakness and reduced exercise tolerance up to two years following discharge from the intensive care unit (ICU). Persistent neuromuscular complications of ARDS may contribute to the functional disability observed in these patients.

Methods:

Sixteen ARDS survivors underwent comprehensive neurological evaluation and standardized electrodiagnostic testing 6 to 24 months after ICU discharge. Four of these patients agreed to open muscle biopsy.

Results:

Seven of sixteen patients had clinically significant focal compressive mononeuropathies. Electrodiagnostic testing failed to reveal any changes attributable to critical illness polyneuropathy or myopathy. All four muscle biopsies were abnormal, and although the pathological features were structurally non-specific, the presence of an acquired myopathy remains possible. Four patients had persistent mixed sensory complaints but had normal electrodiagnostic evaluation.

Conclusions:

The high frequency of mononeuropathies highlights the need for vigilance in daily ICU care. The findings also suggest that complaints of weakness and reduced exercise capacity in ARDS survivors may be related to combined effects of compressive neuropathies and generalized longstanding structural changes in muscle and may support an organic basis for longterm functional disability.

Résumé:

RÉSUMÉ:<span class='italic'><span class='bold'>Contexte</span></span>:

Les survivants du syndrome de détresse respiratoire aiguë (SDRA) se plaignent d’une faiblesse généralisée et d’une diminution de la tolérance à l’effort plus de deux ans après leur congé de l’unité de soins intensifs. Il est possible que des complications neuromusculaires persistantes du SDRAcontribuent à l’invalidité fonctionnelle observée chez ces patients.

<span class='italic'><span class='bold'>Méthodes</span></span>:

Seize survivants du SDRA ont subi une évaluation neurologique complète et un électrodiagnostic standardisé, 6 à 24 mois après leur sortie de l’unité de soins intensifs. Quatre de ces patients ont consenti à subir une biopsie musculaire ouverte.

<span class='italic'><span class='bold'>Résultats</span></span>:

Sept des seize patients avaient des mononeuropathies compressives focales qui étaient significatives au point de vue clinique. L’électrodiagnostic n’a pas révélé de changements attribuables à une polyneuropathie ou à une myopathie reliée à une maladie grave. Les quatre biopsies musculaires étaient anormales et, bien que les anomalies anatomopathologiques n’étaient pas spécifiques au point de vue structural, la présence d’une myopathie acquise demeure possible. Quatre patients se plaignaient de troubles sensitifs mixtes persistants, mais leur évaluation électrodiagnostique était normale.

<span class='italic'><span class='bold'>Conclusions</span></span>:

La fréquence élevée des mononeuropathies démontre qu’il faut être vigilant en ce qui concerne les soins quotidiens à l’unité de soins intensifs. Nos constatations suggèrent également que la faiblesse et la diminution de la tolérance à l’effort chez les survivants du SDRA pourraient être reliées aux effets combinés de neuropathies compressives et de changements structuraux généralisés présents de longue date au niveau des muscles, et que l’invalidité fonctionnelle prolongée a une base organique chez ces patients.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 4 , November 2007 , pp. 427 - 432
Copyright
Copyright © The Canadian Journal of Neurological 2007

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