Neuromuskuläre Folgen der Sepsis

Zusammenfassung

Die „Critical illness”-Polyneuropathie und die „Critical illness”-Myopathien stellen spezifische neuromuskuläre Komplikationen von Sepsis bzw. der mit ihr assoziierten Entzündungsreaktion (SIRS) dar. Klinisch resultiert eine generalisierte Muskelschwäche, die die Entwöhnung vom Respirator verzögert und häufig eine neuromuskuläre Rehabilitation erfordert. Die Pathogenese dieser Sepsis-induzierten Komplikationen ist bis heute nicht ausreichend geklärt. Die Diagnose einer Neuropathie lässt sich elektrophysiologisch stellen, bei den Myopathien ist eine Biopsie erforderlich. Nach Beendigung der Intensivbehandlung bilden sich die Symptome spontan zurück, schwere Verläufe können allerdings lebenslange neuromuskuläre Defizite hinterlassen.

Summary

Critical illness polyneuropathy and critical illness myopathies represent specific neuromuscular sequelae of sepsis. Affected patients have generalized muscle weakness which, in turn, causes delay in weaning from the respirator and requires neuromuscular rehabilitation. The pathogenesis of sepsis-induced neuromuscular syndromes is not clear, but most authors agree that the inflammatory responses of the host triggered by sepsis play a major role. Diagnosis of neuropathy is made by clinical electrophysiology; with repect to myopathy, a biopsy is required to account for the histologic type. The course of either neuropathy and myopathy is monophysic, i.e. symptoms resolve spontaneously after termination of intensive care. Severe cases, however, can have incomplete recovery with life-long deficits.

Sepsis - Komplikationen - Lähmung - Atrophie - Beatmung

Sepsis - complications - paresis - atrophy - weaning failure

Literatur

• 1 Bednarik J, Lukas Z, Vondracek P. Critical illness polyneuromyopathy: the electrophysiological components of a complex entity.  Intensive Care Med. 2003;  29 1505-1514
• 2 Bolton C F. Neuromuscular manifestations of critical illness.  Muscle Nerve. 2005;  32 140-163
• 3 Danon M J, Carpenter S. Myopathy with thick filament (myosin) loss following prolonged paralysis with vecuronium during steroid treatment.  Muscle Nerve. 1991;  14 1131-1139
• 4 De Jonghe B, Sharshar T. et al . Paresis acquired in the intensive care unit: a prospective multicenter study.  JAMA. 2002;  288 2859-2867
• 5 De Letter M ACJ, van Doorn P A. et al . Critical illness polyneuropathy and myopathy (CIPNM): evidence for local immune activation by cytokine-expression in the muscle tissue.  J Neuroimmunol. 2000;  106 206-213
• 6 Di Giovanni S, Molon A, Broccolini A. et al . Constitutive activation of MAPK cascade in acute quadriplegic myopathy.  Ann Neurol. 2004;  55 195-206
• 7 Fletcher S N, Kennedy D D, Ghosh I R. et al . Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness.  Crit Care Med. 2003;  31 1012-1016
• 8 Friedrich O, Hund E, Weber C, Hacke W, Fink R H. Critical illness myopathy serum fractions affect membrane excitability and intracellular calcium release in mammalian skeletal muscle.  J Neurol. 2004;  251 53-65
• 9 Friedrich O, Fink R H, Hund E. Understanding critical illness myopathy: approaching the pathomechanism.  J Nutr. 2005;  135 1813S-1817S
• 10 Garnacho-Montero J, Amaya-Villar R, Garcia-Garmendia J L, Madrazo-Osuna J, Ortiz-Leyba C. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients.  Crit Care Med. 2005;  33 349-354
• 11 Hansen-Flaschen J, Cowen J, Raps E C. Neuromuscular blockade in the intensive care unit. More than we bargained for.  Am Rev Respir Dis. 1993;  147 234-236
• 12 Herridge M S, Cheung A M. et al . One-year outcomes in survivors of the acute respiratory distress syndrome.  N Engl J Med. 2003;  348 683-693
• 13 Hinder F, Ludemann P, Hinder S, Ringelstein E B, Van-Aken H. Prolongierte Muskelschwäche des Intensivpatienten unter besonderer Berücksichtigung der sog. Intensiv-Polyneuromyopathy.  Anaesthesist. 1997;  46 211-219
• 14 Hund E. Myopathy in critically ill patients.  Crit Care Med. 1999;  27 2544
• 15 Hund E. Critical illness polyneuropathy.  Curr Opin Neurol. 2001;  14 649
• 16 Khan J, Harrison T B, Rich M M, Moss M. Early development of critical illness myopathy and neuropathy in patients with severe sepsis.  Neurology. 2006;  67 1421-1425
• 17 Latronico N. Neuromuscular alterations in the critically ill patient: critical illness myopathy, critical illness neuropathy, or both?.  Intensive Care Med. 2003;  29 1411-1413
• 18 Mohr M, Englisch L, Roth A, Burchardi H, Zielmann S. Effects of early treatment with immunoglobulin on critical illness polyneuropathy following multiple organ failure and gram-negative sepsis.  Intensive Care Med. 1997;  23 1144-1149
• 19 Rezaiguia-Delclaux S, Lefaucheur J P, Zakkouri M, Duvoux C, Duvaldestin P, Stephan F. Severe acute polyneuropathy complicating orthotopic liver allograft failure.  Transplantation. 2002;  74 880-882
• 20 Sander H W, Golden M, Danon M J. Quadriplegic areflexic ICU illness: selective thick filament loss and normal nerve histology.  Muscle Nerve. 2002;  26 499-505
• 21 Segredo V, Caldwell J E, Matthay M A, Sharma M L, Gruenke L D, Miller R D. Persistent paralysis in critically ill patients after long-term administration of vecuronium.  N Engl J Med. 1992;  327 524-528
• 22 Tennilä A, Salmi T, Pettilä V, Roine R O, Varpula T, Takkunen O. Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis.  Intensive Care Med. 2000;  26 1360-1363
• 23 van den Berghe G, Wouters P, Weekers F. et al . Intensive insulin therapy in the critically ill patients.  N Engl J Med. 2001;  345 1359-1367
• 24 van den Berghe G, Wilmer A, Hermans G. et al . Intensive insulin therapy in the medical ICU.  N Engl J Med. 2006;  354 449-461
• 25 van der Schaaf M, Beelen A, de Vos R. Functional outcome in patients with critical illness polyneuropathy.  Disabil Rehabil. 2004;  26 1189-1197