KRİTİK HASTALIK POLİNÖROPATİSİ VE MİYOPATİSİ

Abstract

Bilimsel zemin: Kritik hastalığın nöromusküler belirtileri olan polinöropati ve/veya miyopati, yoğun bakım ünitelerinde bir haftadan daha uzun süre yatan hastalarda gelişir. Sıklıkla altta yatan neden sepsis ve/veya çoklu organ yetmezliği veya steroid-nöromusküler kavşak bloke edici ilaç kullanımıdır. Özellikle ekstremite ve solunum kaslarında kuvvet kaybı ve uzamış mekanik ventilasyon ihtiyacına neden olurlar. Polinöropati akut ve aksonal tarzdadır, miyopati ise dört farklı tipte kendini gösterebilir. Genellikle bu hastalıklar gelişmeden önce görülen ensefalopati tablosu hastaların geç tanı almalarına sebebiyet vermektedir. İyi klinik izlem, erken evrede yapılacak elektrofizyolojik ve laboratuar çalışmalar, gerekli durumlarda alınacak biyopsi doğru tanıyı kolaylaştırır. Sıklıkla bir arada görülen bu hastalıkların erken evrede doğru tanı almaları ve ayırıcı tanılarının ayrıntılı yapılması önemlidir, çünkü bu sayede doğru tedavi uygulanabilir, ayrıca sağkalım üzerine doğrudan etkili olan bu hastalıklar ile mücadele edilebilinir. Çıkarımlar: Günümüzde daha iyi tanımlanmaya başlanan risk faktörlerinin elimine edilmesi bu hastalıkların görülebilirliklerini azaltabilir. Henüz özgül bir tedavi olmasa da, destekleyici tedaviler, sepsis ile agresif savaşım, hastalığa neden olabilecek medikal tedavilerin uzaklaştırılması hastaya yarar sağlayabilir.

Anahtar Kelimeler: Kritik hastalık, polinöropati, miyopati

Keywords

• -

References

1. Bolton CF. Neuromuscular manifestations of critical
2. illness. Muscle Nerve 2005;32(2):140-163
3. Visser LH. Critical illness polyneuropathy and
4. myopathy: clinical features, risk factors and
5. prognosis. Eur J Neurol 2006;13(11):1203-1212
6. Hund E. Neurological complications of sepsis:critical
7. illness polyneuropathy and myopathy. J Neurol
8. ;248:929-934

9. Latronico N, Peli E, Botteri M. Critical illness
10. myopathy and neuropathy. Curr Opin Crit Care
11. ;11(2):126-132
12. Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ.
13. Polyneuropathy in critically ill patients. J Neurol
14. Neurosurg Psychiatry 1984;47:1223-1231
15. Bolton CF, Laverty DA, Brown JD, Witt NJ, Hahn
16. AF, Sibbald WJ. Critically ill polyneuropathy:
17. electrophysiological studies and differentiation from
18. Guillain-Barre syndrome. J Neurol Neurosurg
19. Psychiatry 1986;49:563-573
20. Leijten FS, De Weerd AW, Poortvliet DC, De Ridder
21. VA, Ulrich C, Harink-De Weerd JE. Critical illness
22. polyneuropathy in multiple organ dysfunction
23. syndrome and weaning from the ventilator. Intensive
24. Care Med 1996;22(9):856-861
25. Witt NJ, Zochodne DW, Bolton CF, Grand'Maison F,
26. Wells G, Young GB, Sibbald WJ. Peripheral nerve
27. function in sepsis and multiple organ failure. Chest
28. ;99(1):176-184
29. Tennila A, Salmi T, Pettila V, Roine RO, Varpula T,
30. Takkunen O. Early signs of critical illness
31. polyneuropathy in ICU patients with systemic
32. inflammatory response syndrome or sepsis. Intensive
33. Care Med 2000;26(9):1360-1363
34. Druschky A, Herkert M, Radespiel-Troger M,
35. Druschky K, Hund E, Becker CM, Hilz MJ, Erbguth
36. F, Neundorfer B. Critical illness polyneuropathy:
37. clinical findings and cell culture assay of
38. neurotoxicity assessed by a prospective study.
39. Intensive Care Med 2001;27(4):686-693
40. Latronico N, Fenzi F, Recupero D, Guarneri B,
41. Tomelleri G, Tonin P, De Maria G, Antonini L,
42. Rizzuto N, Candiani A. Critical illness myopathy and
43. neuropathy. Lancet 1996;347(9015):1579-1582
44. Fenzi F, Latronico N, Refatti N, Rizzuto N. Enhanced
45. expression of E-selectin on the vascular endothelium
46. of peripheral nerve in critically ill patients with
47. neuromuscular disorders. Acta Neuropathol (Berl)
48. ;106(1):75-82
49. de Letter MA, Schmitz PI, Visser LH, Verheul FA,
50. Schellens RL, Op de Coul DA, van der Meche FG.
51. Risk factors for the development of polyneuropathy
52. and myopathy in critically ill patients. Crit Care Med
53. ;29(12):2281-2286
54. Sander HW, Golden M, Danon MJ. Quadriplegic
55. areflexic ICU illness: selective thick filament loss and
56. normal nerve histology. Muscle Nerve
57. ;26(4):499-505
58. Verheul GA, de Jongh-Leuvenink J, Op de Coul AA,
59. van Landeghem AA, van Puyenbroek MJ. Tumor
60. necrosis factor and interleukin-6 in critical illness
61. polyneuromyopathy. Clin Neurol Neurosurg
62. ;96(4):300-304
63. Coakley JH, Nagendran K, Yarwood GD, Honavar M,
64. Hinds CJ. Patterns of neurophysiological abnormality
65. in prolonged critical illness. Intensive Care Med
66. ;24(8):801-807
67. Zifko UA, Zipko HT, Bolton CF. Clinical and
68. electrophysiological findings in critical illness
69. polyneuropathy. J Neurol Sci 1998;159(2):186-193
70. Op de Coul AA, Lambregts PC, Koeman J, van
71. Puyenbroek MJ, Ter Laak HJ, Gabreels-Festen AA.
72. Neuromuscular complications in patients given
73. Pavulon (pancuronium bromide) during artificial
74. ventilation. Clin Neurol Neurosurg 1985;87(1):17-22
75. Kupfer Y, Namba T, Kaldawi E, Tessler S. Prolonged
76. weakness after long-term infusion of vecuronium
77. bromide. Ann Intern Med 1992;117(6):484-486
78. Khan J, Harrison TB, Rich MM, Moss M. Early
79. development of critical illness myopathy and
80. neuropathy in patients with severe sepsis. Neurology
81. ;67(8):1421-1425
82. Low PA NK, Seionti L. Role of hypoxia, oxidative
83. stress, and excitatory neurotoxins in diabetic
84. neuropathy. In: Dyck PJ TP, editor. Diabetic
85. neuropathy. 2nd ed. Philadelphia: WB Saunders;
86. p 317-329
87. Maher J, Rutledge F, Remtulla H, Parkes A, Bernardi
88. L, Bolton CF. Neuromuscular disorders associated
89. with failure to wean from the ventilator. Intensive
90. Care Med 1995;21(9):737-743
91. Sander HW, Saadeh PB, Chandswang N, Greenbaum
92. D, Chokroverty S. Diaphragmatic denervation in
93. intensive care unit patients. Electromyogr Clin
94. Neurophysiol 1999;39(1):3-5
95. Hund E, Genzwurker H, Bohrer H, Jakob H, Thiele R,
96. Hacke W. Predominant involvement of motor fibres
97. in patients with critical illness polyneuropathy. Br J
98. Anaesth 1997;78(3):274-278
99. Rich MM, Teener JW, Raps EC, Schotland DL, Bird
100. SJ. Muscle is electrically inexcitable in acute
101. quadriplegic myopathy. Neurology 1996;46(3):731-
102. -
103. Zochodne DW, Bolton CF, Wells GA, Gilbert JJ,
104. Hahn AF, Brown JD, Sibbald WA. Critical illness
105. polyneuropathy. A complication of sepsis and
106. multiple organ failure. Brain 1987;110 ( Pt 4):819-
107. -
108. Lycklama J NA, Troost J. Critical illness
109. polyneuropathy. In: WB M, editor. Handbook of
110. clinical neurology. New York: Elsevier Science;
111. p 129-135
112. Dellinger RP, Carlet JM, Masur H, Gerlach H,
113. Calandra T, Cohen J, Gea-Banacloche J, Keh D,
114. Marshall JC, Parker MM, Ramsay G, Zimmerman JL,
115. Vincent JL, Levy MM. Surviving Sepsis Campaign
116. guidelines for management of severe sepsis and septic
117. shock. Intensive Care Med 2004;30(4):536-555
118. Lowry SF. Sepsis and its complications: clinical
119. definitions and therapeutic prospects. Crit Care Med
120. ;22(7):S1-2
121. -
122. Marmara Medical Journal 2008;21(2);193-202
123. Kayıhan Uluç, Ark.
124. Kritik hastalık polinöropatisi ve miyopatisi
125. Garnacho-Montero J, Madrazo-Osuna J, GarciaGarmendia
126. JL, Ortiz-Leyba C, Jimenez-Jimenez FJ,
127. Barrero-Almodovar A, Garnacho-Montero MC,
128. Moyano-Del-Estad MR. Critical illness
129. polyneuropathy: risk factors and clinical
130. consequences. A cohort study in septic patients.
131. Intensive Care Med 2001;27(8):1288-1296
132. Bolton CF, Young GB, Zochodne DW. The
133. neurological complications of sepsis. Ann Neurol
134. ;33(1):94-100
135. van der Schaaf M, Beelen A, de Groot IJ. Critical
136. illness polyneuropathy: a summary of the literature on
137. rehabilitation outcome. Disabil Rehabil
138. ;22(17):808-810
139. van der Schaaf M, Beelen A, de Vos R. Functional
140. outcome in patients with critical illness
141. polyneuropathy. Disabil Rehabil 2004;26(20):1189-
142. -
143. Leijten FS, Harinck-de Weerd JE, Poortvliet DC, de
144. Weerd AW. The role of polyneuropathy in motor
145. convalescence after prolonged mechanical ventilation.
146. Jama 1995;274(15):1221-1225
147. Mohr M, Englisch L, Roth A, Burchardi H, Zielmann
148. S. Effects of early treatment with immunoglobulin on
149. critical illness polyneuropathy following multiple
150. organ failure and gram-negative sepsis. Intensive Care
151. Med 1997;23(11):1144-1149
152. van den Berghe G, Wouters P, Weekers F, Verwaest
153. C, Bruyninckx F, Schetz M, Vlasselaers D,
154. Ferdinande P, Lauwers P, Bouillon R. Intensive
155. insulin therapy in the critically ill patients. N Engl J
156. Med 2001;345(19):1359-1367
157. Van den Berghe G, Schoonheydt K, Becx P,
158. Bruyninckx F, Wouters PJ. Insulin therapy protects
159. the central and peripheral nervous system of intensive
160. care patients. Neurology 2005;64(8):1348-1353
161. Langouche L, Vanhorebeek I, Vlasselaers D, Vander
162. Perre S, Wouters PJ, Skogstrand K, Hansen TK, Van
163. den Berghe G. Intensive insulin therapy protects the
164. endothelium of critically ill patients. J Clin Invest
165. ;115(8):2277-2286
166. Mesotten D, Swinnen JV, Vanderhoydonc F, Wouters
167. PJ, Van den Berghe G. Contribution of circulating
168. lipids to the improved outcome of critical illness by
169. glycemic control with intensive insulin therapy. J Clin
170. Endocrinol Metab 2004;89(1):219-226
171. Douglass JA, Tuxen DV, Horne M, Scheinkestel CD,
172. Weinmann M, Czarny D, Bowes G. Myopathy in
173. severe asthma. Am Rev Respir Dis 1992;146(2):517-
174. -
175. Campellone JV, Lacomis D, Kramer DJ, Van Cott
176. AC, Giuliani MJ. Acute myopathy after liver
177. transplantation. Neurology 1998;50(1):46-53
178. Perea M, Picon M, Miro O, Orus J, Roig E, Grau JM.
179. Acute quadriplegic myopathy with loss of thick
180. (myosin) filaments following heart transplantation. J
181. Heart Lung Transplant 2001;20(10):1136-1141
182. Rich MM, Pinter MJ, Kraner SD, Barchi RL. Loss of
183. electrical excitability in an animal model of acute
184. quadriplegic myopathy. Ann Neurol 1998;43(2):171-
185. -
186. Rich MM, Pinter MJ. Sodium channel inactivation in
187. an animal model of acute quadriplegic myopathy.
188. Ann Neurol 2001;50(1):26-33
189. Rich MM, Pinter MJ. Crucial role of sodium channel
190. fast inactivation in muscle fibre inexcitability in a rat
191. model of critical illness myopathy. J Physiol
192. ;547(Pt 2):555-566
193. Brealey D, Brand M, Hargreaves I, Heales S, Land J,
194. Smolenski R, Davies NA, Cooper CE, Singer M.
195. Association between mitochondrial dysfunction and
196. severity and outcome of septic shock. Lancet
197. ;360(9328):219-223
198. Tiao G, Hobler S, Wang JJ, Meyer TA, Luchette FA,
199. Fischer JE, Hasselgren PO. Sepsis is associated with
200. increased mRNAs of the ubiquitin-proteasome
201. proteolytic pathway in human skeletal muscle. J Clin
202. Invest 1997;99(2):163-168
203. Sher JH, Shafiq SA, Schutta HS. Acute myopathy
204. with selective lysis of myosin filaments. Neurology
205. ;29(1):100-106
206. Showalter CJ, Engel AG. Acute quadriplegic
207. myopathy: analysis of myosin isoforms and evidence
208. for calpain-mediated proteolysis. Muscle Nerve
209. ;20(3):316-322
210. Sitwell LD, Weinshenker BG, Monpetit V, Reid D.
211. Complete ophthalmoplegia as a complication of acute
212. corticosteroid- and pancuronium-associated
213. myopathy. Neurology 1991;41(6):921-922
214. Zochodne DW, Ramsay DA, Saly V, Shelley S,
215. Moffatt S. Acute necrotizing myopathy of intensive
216. care: electrophysiological studies. Muscle Nerve
217. ;17(3):285-292