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Malengreaux C, Minguet P, Colson C, Dardenne N, Misset B, Rousseau AF. Incidence and risk factors of peripheral nerve injuries 3 months after ICU discharge: a retrospective study comparing COVID-19 and non-COVID-19 critically ill survivors. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:10. [PMID: 38336831 PMCID: PMC10858596 DOI: 10.1186/s44158-024-00144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Peripheral nerve injuries (PNI) have been associated with prone positioning (PP) in mechanically ventilated (MV) patients with COVID-19 pneumonia. The aims of this retrospective study were to describe PNI prevalence 3 months (M3) after intensive care unit (ICU) discharge, whether patients survived COVID-19 or another critical illness, and to search for risk factors of PNI. RESULTS A total of 55 COVID (62 [54-69] years) and 22 non-COVID (61.5 [48-71.5] years) patients were followed at M3, after an ICU stay of respectively 15 [9-26.5] and 13.5 [10-19.8] days. PNI symptoms were reported by 23/55 (42.6%) COVID-19 and 8/22 (36%) non-COVID-19 patients (p = 0.798). As the incidence of PNI was similar in both groups, the entire population was used to determine risk factors. The MV duration predicted PNI occurrence (OR (CI95%) = 1.05 (1.01-1.10), p = 0.028), but not the ICU length of stay, glucocorticoids, or inflammation biomarkers. CONCLUSION In the present cohort, PNI symptoms were reported in at least one-third of the ICU survivors, in similar proportion whether patients suffered from severe COVID-19 or not.
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Affiliation(s)
- C Malengreaux
- Department of Intensive Care and Burn Centre, University Hospital of Liège, Avenue de L'Hôpital,1, University of Liège, Sart-Tilman B35, Liège, B-4000, Belgium.
| | - P Minguet
- Department of Intensive Care and Burn Centre, University Hospital of Liège, Avenue de L'Hôpital,1, University of Liège, Sart-Tilman B35, Liège, B-4000, Belgium
| | - C Colson
- Department of Intensive Care and Burn Centre, University Hospital of Liège, Avenue de L'Hôpital,1, University of Liège, Sart-Tilman B35, Liège, B-4000, Belgium
| | - N Dardenne
- University and Hospital Biostatistics Centre (B-STAT), University of Liège, Liège, Belgium
| | - B Misset
- Department of Intensive Care and Burn Centre, University Hospital of Liège, Avenue de L'Hôpital,1, University of Liège, Sart-Tilman B35, Liège, B-4000, Belgium
| | - A F Rousseau
- Department of Intensive Care and Burn Centre, University Hospital of Liège, Avenue de L'Hôpital,1, University of Liège, Sart-Tilman B35, Liège, B-4000, Belgium
- GIGA-Research, GIGA-I3 Thematic Unit, Inflammation and Enhanced Rehabilitation Laboratory (Intensive Care), University of Liège, Liège, Belgium
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Daste C, Mihoubi F, Roren A, Dumitrache A, Carlier N, Benghanem S, Ruttimann A, Mira JP, Pène F, Roche N, Seror P, Nguyen C, Rannou F, Drapé JL, Lefèvre-Colau MM. Early shoulder-girdle MRI findings in severe COVID-19-related intensive care unit-acquired weakness: a prospective cohort study. Eur Radiol 2023:10.1007/s00330-023-09468-5. [PMID: 36912923 PMCID: PMC10010198 DOI: 10.1007/s00330-023-09468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 12/23/2022] [Accepted: 01/22/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To describe clinical and early shoulder-girdle MR imaging findings in severe COVID-19-related intensive care unit-acquired weakness (ICU-AW) after ICU discharge. METHODS A single-center prospective cohort study of all consecutive patients with COVID-19-related ICU-AW from November 2020 to June 2021. All patients underwent similar clinical evaluations and shoulder-girdle MRI within the first month and then 3 months (± 1 month) after ICU discharge. RESULTS We included 25 patients (14 males; mean [SD] age 62.4 [12.5]). Within the first month after ICU discharge, all patients showed severe proximal predominant bilateral muscular weakness (mean Medical Research Council total score = 46.5/60 [10.1]) associated with bilateral, peripheral muscular edema-like MRI signals of the shoulder girdle in 23/25 (92%) patients. At 3 months, 21/25 (84%) patients showed complete or quasi-complete resolution of proximal muscular weakness (mean Medical Research Council total score > 48/60) and 23/25 (92%) complete resolution of MRI signals of the shoulder girdle, but 12/20 (60%) patients experienced shoulder pain and/or shoulder dysfunction. CONCLUSIONS Early shoulder-girdle MRI findings in COVID-19-related ICU-AW included muscular edema-like peripheral signal intensities, without fatty muscle involution or muscle necrosis, with favorable evolution at 3 months. Precocious MRI can help clinicians distinguish critical illness myopathy from alternative, more severe diagnoses and can be useful in the care of patients discharged from intensive care with ICU-AW. KEY POINTS • We describe the clinical and shoulder-girdle MRI findings of COVID-19-related severe intensive care unit-acquired weakness. • This information can be used by clinicians to achieve a nearly specific diagnosis, distinguish alternative diagnoses, assess functional prognosis, and select the more appropriate health care rehabilitation and shoulder impairment treatment.
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Affiliation(s)
- Camille Daste
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004, Paris, France
| | - Fadila Mihoubi
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Radiologie Ostéo-Articulaire, 75014, Paris, France
| | - Alexandra Roren
- AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004, Paris, France
| | - Alina Dumitrache
- AP-HP. Centre-Université de Paris Cité, Hôpital Corentin Celton, Service de Rééducation Et de Réadaptation, 92130, Issy-Les-Moulineaux, France
| | - Nicolas Carlier
- AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Pneumologie, 75014, Paris, France
| | - Sarah Benghanem
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Médecine Intensive Et Réanimation, 75014, Paris, France.,Neurophysiology Department, GHU Psychiatrie Et Neurosciences, Sainte Anne Hospital, 75014, Paris, France
| | - Aude Ruttimann
- AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Médecine Intensive Et Réanimation, 75014, Paris, France
| | - Jean-Paul Mira
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Médecine Intensive Et Réanimation, 75014, Paris, France
| | - Frédéric Pène
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Médecine Intensive Et Réanimation, 75014, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR8104, 75006, Paris, France
| | - Nicolas Roche
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Pneumologie, 75014, Paris, France
| | - Paul Seror
- Laboratoire d'électroneuromyographie, 146 Av Ledru Rollin, 75011, Paris, France
| | - Christelle Nguyen
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire Et Biomarqueurs (T3S), Centre Universitaire Des Saints-Pères, 75006, Paris, France
| | - François Rannou
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire Et Biomarqueurs (T3S), Centre Universitaire Des Saints-Pères, 75006, Paris, France
| | - Jean-Luc Drapé
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Radiologie Ostéo-Articulaire, 75014, Paris, France
| | - Marie-Martine Lefèvre-Colau
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France. .,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France. .,INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004, Paris, France.
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Tankisi A, Pedersen TH, Bostock H, Z'Graggen WJ, Larsen LH, Meldgaard M, Elkmann T, Tankisi H. Early detection of evolving critical illness myopathy with muscle velocity recovery cycles. Clin Neurophysiol 2021; 132:1347-1357. [PMID: 33676846 DOI: 10.1016/j.clinph.2021.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/29/2020] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the sensitivity of muscle velocity recovery cycles (MVRCs) for detecting altered membrane properties in critically ill patients, and to compare this to conventional nerve conduction studies (NCS) and quantitative electromyography (qEMG). METHODS Twenty-four patients with intensive care unit acquired weakness (ICUAW) and 34 healthy subjects were prospectively recruited. In addition to NCS (median, ulnar, peroneal, tibial and sural nerves) and qEMG (biceps brachii, vastus medialis and anterior tibial muscles), MVRCs with frequency ramp were recorded from anterior tibial muscle. RESULTS MVRC and frequency ramp parameters showed abnormal muscle fiber membrane properties with up to 100% sensitivity and specificity. qEMG showed myopathy in 15 patients (63%) while polyneuropathy was seen in 3 (13%). Decreased compound muscle action potential (CMAP) amplitude (up to 58%) and absent F-waves (up to 75%) were frequent, but long duration CMAPs were only seen in one patient with severe myopathy. CONCLUSIONS Altered muscle fiber membrane properties can be detected in patients with ICUAW not yet fulfilling diagnostic criteria for critical illness myopathy (CIM). MVRCs may therefore serve as a tool for early detection of evolving CIM. SIGNIFICANCE CIM is often under-recognized by intensivists, and large-scale longitudinal studies are needed to determine its incidence and pathogenesis.
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Affiliation(s)
- A Tankisi
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - T H Pedersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - H Bostock
- Institute of Neurology, University College London, Queen Square House, London, United Kingdom
| | - W J Z'Graggen
- Departments of Neurology and Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - L H Larsen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - M Meldgaard
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - T Elkmann
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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