Zochodne DW et al24 (1987)
|
case series, retrospective;
single center;
ICU; clinical and electrophysiological aspects
|
N= 19;
(9 M, 10 F, mean age 64);
CIP = 19
|
cardiac or pulmonary diseases;
5 pts had cerebral lesion (4 infarction,
1 brain injury)
|
10 mos-2 yrs
|
none
|
EMG, histological
examination
|
8 (88.8%) pts showed good functional recovery. Of these 6 pts had EMG improvement within 3 months. At 2 yrs one patients had mildly weak dorsiflexion of right foot and one had mild distal limb weakness.
11 (58%) pts died
|
Coronel B et al25 (1990)
|
case series,
retrospective;
2 ICU center;
occurrence and clinical features
|
N=15/4
(12 M, 3 F, mean age 47);
CIP= 15
|
cardiac or pulmonary disorders
|
1-8 yrs
|
none
|
EMG, muscle biopsy
|
1 (25%) pt had complete recovery;
3 pts: 2 pts had persisting dysesthesia;
1 needing assistance to sit and walk;
Death: 5 pts (33%)
|
Op de Cul et al2 (1991)
|
case series,
retrospective;
ICU; clinical and electrophysiological features
|
N= 22*;
(17 M, 5 F, mean age 55)
CP= 22
|
Multiple trauma with brain injury (5 pts), pulmonary and infections
|
2-10 mos
|
none
|
EMG, muscle biopsy (7 pts)
|
9 (64.2%) pts had complete functional recovery; 5 (22.7%) pts: incomplete recovery;
8 pts died.
|
Witt NJ et al26 (1991)
|
case series,
prospective;
ICU; clinical and electrophysiological features
|
N= 30;
CIP= 30, of these 25 had clinical signs of PN and 15 pts ES signs
|
multiple medical and surgical diseases; 25% had head trauma and brain lesions
|
mean 72 days (10-190)
|
none
|
EMG
|
20 (66.6%) pts gained full recovery;
3 (10%) with severe CIP showed severe disability and ultimately died.
|
Rossiter A et al27 (1991)
|
case reports,
retrospective;
single center;
ICU; clinical report after pancuronium discontinuation
|
N= 5 pts;
(4 M, 1 F);
CIPNM = 5
|
medical disorders
|
5 mos
|
none
|
EMG; clinical examination
|
none had complete recovery:
1 pt severe disability at 3 months;
1 pt with tetraparesis was able to walk with assistance at 5 months;
1 pt with tetraparesis was unable to walk at 1 month;
2 pts died
|
Gooch JL et al28 (1993)
|
case series,
retrospective;
paralysis after neuromuscular junction blockade
|
N = 12£;
age range 3.5 mos-64 yrs;
CIP= 12
|
medical disorders
|
3-6 mos
|
none
|
MRC; EMG, muscle biopsy (2 pts)
|
5 (50%) pts recovered completely;
5 pts incomplete recovery;
2 pts died
|
Giostra E et al29 (1994)
|
case series,
retrospective;
ICU;
paralysis after neuromuscular junction blockade
|
N= 9;
(6 M, 3 F, mean age 65.6 +10.3);
N= CIPNM
|
medical and pulmonary disorders.
|
4 -52 wks
|
none
|
EMG, muscle biopsies (7 pts)
|
5 (55.5%) pts had complete recovery. Even if recovery was usual, residual peroneal palsy was frequent
|
Leijten F et al30 (1995)
|
prospective
cohort study; single center ICU, post-ICU; incidence and risk factors
|
N= 29°;
CIP = 29
(21 M 8 F; mean age 59.7±13.9 years);
N = 12 evaluated to follow-up
|
surgical and medical disorders;
3 pts cerebral surgery, multiple trauma (n=9), cardiac resuscitation (n=5), intracranial
hemorrhage (n=2)
|
1 yr
|
none;
endpoint was strength greater than MRC grade 4/5 in all muscles with ability to walk for more than 50 m without aid or ataxia
|
neurological examination; MRC; EMG;
|
7 (58.3%) patients recovered (4 pts within 3 days and 4 weeks, 3 pts within 4 weeks and 1 year;
5 (41.7%) pts had severe disability after year;
9 (31%) pts died
|
Latronico N et al31 (1996)
|
case series,
prospective;
single center ICU; incidence and risk factors
|
N= 24;
(19 M, 5 F, mean age 50.2±20.9 yrs);
CIPNM = 24
|
All patients had NCS lesions: 13 head trauma;
6 subarachnoid hemorrhage;
3 stroke; 1 cerebral hemorrhage
|
8-18 mos
|
none
|
EMG/ENG; nerve biopsy (22 pts)
|
7 survivors: 6 (85.7%) had recovered well or had only moderate disability (able to walk unassisted with full muscle strength);
1 was in vegetative state;
17 (70.8%) pts died
|
Berek K et al32 (1996)
|
case series,
prospective;
ICU;
incidence, severity and course of polyneuropathies in patients with sepsis or systemic inflammatory response syndrome
|
N=22/15;
(17 M, 5 F, mean age 51.2 yrs);
CIPNM = 18
|
medical and surgical disorders
|
2-3mos
|
functional disability score$
|
EMG
|
9 (50%) pts had complete functional recovery;
6 pts had incomplete functional recovery. Of these, 4 pts had mild weakness and 2 pts had moderate weakness.
Good tendency for recovery in all surviving patients, electrophysiologic findings were still pathologic in 11 patients at the follow-up;
7 (50%) pts died
|
Hund EF et al33 (1996)
|
case series,
prospective;
single center
ICU;
|
N= 7
(3 M, 4 F; mean age 47.7±16.8
|
medical disorders;
3 pts with cerebral lesions
|
3 mos - 3.5 yrs
|
none
|
EMG; muscle and nerve biopsy (3 pts)
|
2 (40%) pt gained complete recovery;
3 pts showed disability due to CNS lesions;
2 pts died
|
Campellone JV et al34
(1998)
|
case series, prospective; single center ICU; frequency of myopathy as a cause of generalized
weakness and potential risk factors after
liver transplant
|
N= 7/6;
(6 M, 1 F; mean age 57.7±9.3)
CIM = 7
|
liver transplant
|
11-41 days (5 pts) and 67 days (1 pt)
|
none
|
EMG; muscle biopsies (5 pts)
|
3 (50%) pts regained strength slowly and were able to ambulate within 4 to 12 weeks;
1 pt required a walker;
2 pts died
|
Lacomis D. et al35 (1997)
|
cohort,
retrospective; single center ICU;
causes of ICU weakness
|
N= 92;
N=49
CIM = 37 ** CIP= 12
|
surgical, medical and pulmonary disorders
|
12 – 60 mos
|
none
|
EMG; muscle biopsies (22 pts).
|
25 (75.7%) pts had complete functional recovery: 17 pts were ambulatory within 4 months and 8 pts within 4-12 months;
7 pts showed incomplete functional recovery: 4 remained non ambulatory and 3 remained
dependent on the ventilator;
16 pts died
|
de Sèze M. et al36 (2000)
|
cohort, retrospective;
single center;
rehabilitation; the features and
outcome patients who had severe forms of CIP
|
N= 19, only CIP (14 M 5 F; mean age 55,9 yrs)
|
medical disorders
|
2 yrs
|
none
|
MRC;
sensory findings
|
11 (64.7%) patients recovered completely;
4 (23.5%) patients remained quadriplegic; 2 patients remained quadriparetic;
2 pts died
|
Zifko UA et al37 (2000)
|
cohort,
retrospective;
ICU and rehabilitation; clinical outcome and electrophysiological findings
|
N = 26;
CIP= 13, (9 M, 4 F, age between 22-83 yrs);
N = 7 refused to participate;
|
medical disorders;
1 pt with stroke
|
13-24 mos (mean 17 mos)
|
none
|
EMG/ENG; MRC; clinical examination
|
only 2 (15.3%) pts had full recovery; 11 of 13 patients with CIP had clinical manifestations, at follow-up (13–24 months after diagnosis);
6 pts died
|
16 De Jonghe B. et al38 (2002)
|
cohort, prospective; multicenter
ICU and post-ICU; clinical incidence, risk factors, and outcomes of ICU acquired paresis (ICUAP) during ICU stay
|
N= 95;
CIP (ICUAP)= 24;
(12M, 12F; mean age 67,6 yrs)
|
surgical and medical disorders; patients were excluded if they had disease of the peripheral nervous system, or brainstem lesions
|
9 mos
|
none
|
MRC; EMG; muscle biopsy (10 pts)
|
15 (88.6%) patients had recovered an MRC score of 48 or higher at follow-up;
1 pt lost to follow-up;
7 pts died
|
Fletcher S.N. et al39 (2003)
|
cohort, prospective study; multicenter post-ICU;
prevalence, clinical characteristics
and electrophysiological features
|
N= 22;
CIP= 22;
(mean age 62 yrs, range 45-78);
|
surgical and medical disorders
|
3.5 yrs (range, 12-57 mos)
|
Barthel Index
|
neurologic examination;
EMG
|
19 (86.3%) pts had full recovery (BI score 95-100); 2 pts incomplete recovery (BI score 85);
1 pts severe disabled. 95% patients had electromyographic evidence of chronic partial denervation, indicative of a preceding axonal neuropathy
|
Kerbaul et al6 (2004)
|
cohort,
prospective;
single center post-ICU; to describe patterns of neuromuscular weakness by EMG and biopsy; functional outcome
|
N= 15 pts; (9M, 6F; median age 53 yrs, range 33-82);
CIP = 6
CIM = 6;
CIP/CIM = 3
|
heart-surgery
|
12 mos
|
none,
the endpoints
were death or time to ambulation without assistance;
|
EMG; muscular/nerve biopsy (all pts)
|
6 (75%) had good recovery; 2 subjects of the 8 survivors were not ambulatory;
7 (46%) pts died
|
Van der schaaf M et al40 (2004)
|
prospective observational cohort study + cross-sectional study; single center ICU, post-ICU; to evaluate the functional outcome of ICU patients
|
N= 16;
(12 M, 4 F; mean age 67 years);
CIP = 16
|
medical and surgical disorders; patients with neurological disorders due CNS injury were excluded
|
6 mos and 1 yr
|
Barthel Index; Jebsen hand function test; rivermead mobility index;
timed UP & GO walking test
|
MRC; SIP-68;
SF-36;
IPA questionnaire
|
At 6 mos, 8 pts were evaluated and all showed moderate disability (activity and participation); at 1 yr, 5 (31.2%) pts were evaluated: improvement in functional abilities with wide variation in functional outcome among the patients; functional impairment was still dominant in four out of 5 surviving pts. Outdoor mobility was reduced;
9 (56.2%) patients died
|
Guarneri B et al22 (2008)
|
prospective cohort;
multicenter post-ICU; to evaluate the long-term
follow-up
|
N= 92;
CIP= 15,
(12 M 3 F;
mean age 44.7±14.9 yrs);
CIP= 4
CIM= 6
CIP/CIM= 3
2 = undetermined
|
surgical and medical disorders;
(intracerebral haemorrhage, metabolic encephalopathy, post-anoxic
encephalopathy: 1 patient each); 5 multiple trauma patients; 3 head trauma
|
1 yr
|
global motor performance$
|
MRC; EMG; neurological examination
|
8 (61.5%) patients recovered; 2 (13.3%) patients had persisting muscle weakness; 1 patient remained tetraparetic; 1 patient remained tetraplegic;
1 patient lost to follow-up;
2 patients died;
|
Intiso D et al41 (2011)
|
cohort prospective;
single center neuro-rehabilitation;
to evaluate the long-term functional outcome and health status
|
N= 42 (23M, 19F, mean age 58.4 ± 13.9);
CIP= 30 CIM= 6 CIP/CIM= 6
|
19 pts had CNS damage
|
5 yrs; mean 31.7±15.8 months
|
Barthel and
modified Rankin Scales (mRS);
|
SF-36 questionnaire
|
31 (73.8%) pts (24 pts with just CIPNM and 7 pts with CIPNM and CNS involvement) gained good recovery: mean Barthel of 86.7±15.9 (P < 0.001), and the median mRS of 1 (IQR: 0–3), respectively, at follow-up (mean 31.7±15.8 months)
|
Novak P et al42 (2011)
|
cohort,
prospective;
single center rehabilitation; outcome to ICF
|
N= 27;
(16 F, 11 M; mean age 59.4±15.9);
CIP= 27
|
not reported
|
from admission to discharge (9-102 days)
|
FIM; 6-min (expressed in meters) and 10-meters walking test (expressed in speed velocity); ICF check list
|
sum of muscles strength;
|
Significant functional improvement; mean FIM score 78.7±24.12 and 103.3± 20.5 at admission and discharge, respectively (p<0.001); 6 -min walking test (m): 77.3±115.3 and 191.5±178.2, at admission and discharge, respectively (p<0.001). Considering ICF, 26 (96.2%) pts improved activities and participation
|
Semmler A. et al43 (2013)
|
cohort,
retrospective observational;
single center post-ICU; long-term outcome
|
N = 51;
(26 M, 24 F; median age 57 yrs, range 19–75);
CIP= 21,
no CIM or CIP/CIM
|
Subjects with CNS lesion were excluded
|
6-24 mos, median 11 mos
|
ODSS$; median ODSS scores 1 (range 0–8);
|
MRC; median MRC sum scores 56 (range 47-60);
EMG/ENG; neurological examination
|
Good recovery; pts with diagnosis of CIP showed a higher ODSS scores 1 and lower MRC sum scores 56;
The neuromuscular long-term consequences of critical illness were not severe, suggesting a favorable prognosis of ICU-acquired muscular weakness
|
Koch S et al23 (2014)
|
Prospective cohort;
post-ICU; prediction of long-term outcome in CIP and CIM
|
N= 26;
(20 M, 6 F; mean age 46 yrs);
CIM= 8,
CIP/CIM= 11,
Control = 7
|
multiple trauma (n=12)
|
1 yr;
(mean 411±121 days)
|
functional health status$
|
MRC; EMG; dmMCAP, neCMAP; neurological examination
|
4 (50%) of the CIM patients reached normal physical capacity. In contrast, only 3 (27%) of CIM/CIP patients did so at 1year. Four (36%) of CIM/CIP pts still needed assistance to perform daily life activities: 2 pts were able to walk only within their homes and 2 were only able to stand with help or not at all.
|
Nguyen The N et al44 (2015)
|
Cohort, prospective longitudinal observational; single center;
neurology; incidence and distribution of CIP/CIM subtypes and the evaluation of the risk factors and outcomes
|
N = 133 pts
N= 73 pts;
CIP= 35;
CIM= 16;
CIP/CIM=
22;
controls = 60
|
medical disorders
|
3 mos
|
none
|
MRC; EMG; ONLS
|
At the end of the follow-up duration (90 days), 31 pts with CIP/CIM were evaluated: the ONLS scores improved but remained significantly higher in comparison to non-CIP (2.7 vs 0.8, p = 0.015);
36 (49%) died
|
Intiso D et al45 (2017)
|
prospective cohort study; single center, neuro-rehabilitation setting; functional recovery in subjects with sABI and CIPNM
|
N= 36;
(27 M, 9 F, mean age 56.2±14.8 yrs)
CIP = 36;
N= 75 controls (sABI)
|
patients with sABI
|
107 days (65-146)
|
LCF, DRS, GOS, mRS
|
LOS
|
The magnitude of these improvements was different between the groups, showing that patients with sABI only had a better improvement than those with CIPNM+sABI for mRS and DRS at discharge.
Subjects with sABI + CPNM showed 25.94 (23.33-28.86), 19.71 (17.42-22.31) to DRS and 2.76 (2.51-3.05) and 3.12 (2.84-3.42) to GOS, at admission and discharge, respectively.
|
Cunningham CJB et al46 (2018)
|
prospective observational;
case-control;
rehabilitation setting;
prevalence of CIPNM in rehabilitative setting and
impact of CIPNM on function
|
N= 23, (19 M, 4 F, mean age 43.6 ± 14.7);
CIP= 16;
CIM= 2;
CIP/CIM= 5
controls = 10
|
medical disorders,
12 pts had SCI 2 pts stroke and one TBI
|
1 yr
|
FIM; FIM gain and FIM efficiency
|
EMG/ES; rehabilitation length of stay (RLOS), and discharge disposition
|
FIM score: 64.1 and 89.7 at admission; 78.4 and 94.6, at discharge in pts with CIPNM and without CIPNM, respectively. The gains in FIM scores and RLOS were greater, leading to similar FIM efficiency (FIM points gained/day of rehabilitation) compared with
those without CIPNM (only for 13 pts). Those with CIPNM were less likely to be discharged directly home (57% versus 90%). At 1 year, recovery was seen in 80% of those with CIM and 55% of those with CIM/CIP
|
Symeonidou Z et al47 (2019)
|
multicenter;
retrospective observational;
rehabilitation setting; functional recovery
|
N= 28 pts (19 M, 9 F, mean age 53.6±14.5); CIP= 28
|
medical disorders; cerebral or spinal cord injury or stroke were excluded
|
109.4±70.7 days
|
Barthel Index; ADL
|
MRC, sensory examination
|
Mean Barthel score at admission and discharge improved significantly (15.3 ± 9.1 vs 63.6 ± 21.6, p<0.05);
3 (10.7%) pts had complete recovery;
13 (46.4%) pts incomplete recovery (Barthel score 65-80); 5 pts had severe disability, at discharge
|
Hakiki B et al48 (2021)
|
Single; retrospective observational; rehabilitation setting; functional recovery
|
N = 224 pts; (81 (36%) females, age
68.73);
CIPNM = 119
|
patients with sABI
|
3.8 mos
|
CRS-R; FIM; GOS-E; FOIS
|
ENG/EMG
|
All patients gained functional improvement at discharge: P < .001 for FOIS, FIM and GOS-E), but those with a concomitant CIPNM achieved significantly lower scores (P < .001 for FIM and GOS-E). The CIPNM absence was associated with a higher probability to achieve functional autonomy
|