Neuromuscular Complications of ICU
05 November 2004
-ICU myopathy (acute necrotising myopathy, asthma myopathy
floppy person syndrome)
2.Neuromuscular junction abnormalities
-Myasthenia like syndrome
-Prolonged neuromuscular blockade
-Acute motor neuropathy (Acute axonal variant of GBS)
-Nutritional neuropathy (B1, B6, B12, Vitamin E)
5.Others: Hopkins syndrome
Increased catabolism, immobility & especially neuromuscular blockers contributory factors.
Common baseline condition upon which other processes (myopathy, neuropathy) are superimposed.
Muscle biopsy: uniform reduction in fibre size without patchy necrosis, Type IIB muscle atrophy nonspecific.
Spectrum: ICU (cachectic) myopathy
Myopathy with selective loss of myosin filaments
Acute necrotising myopathy / Panfascicular muscle necrosis
Facial, ocular and respiratory muscles generally spared.
36% intubated asthmatic patients
76% patients with CK>200
Lung > liver > renal transplant
Inotropes (B2 agonists): ventolin, adrenaline
LP if concerned re possibility of Guillain Barre Syndrome
EMG: polyphasic, low amplitude recruitment.
Biopsy: loss of thick myosin filaments, necrosis.
(Panfascicular muscle necrosis: Sudden, generalised weakness of
muscles accompanied by markedly increased CK, sometimes myoglobinuria.)
1. Steroids: lowest dose possible for primary disease.
2. Neuromuscular blockers: Intermittent bolus preferred over continuous as
lower total dosage.
Avoid vecuronium & pancuronium as unpredictable prolonged activity of drug or its metabolite.
Atracurium preferred as nonorgan dependent metabolic pathway.
3. B2 agonist: infuse at lowest dose possible.
Regularly measure blood & lactate levels.
4. Metabolic control: Treat fever
Correct hypoalbuminemia, hyperglycemia, hypophosphatemia, hypokalemia, hypermagnesemia, hypercapneic acidosis.