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Sekhniashvili M, Baum P, Toyka KV. Temporary and highly variable recovery of neuromuscular dysfunction by electrical stimulation in the follow-up of acute critical illness neuromyopathy: a pilot study. Neurol Res Pract 2023; 5:66. [PMID: 38151742 PMCID: PMC10753844 DOI: 10.1186/s42466-023-00293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/23/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND In sepsis-associated critical illness neuromyopathy (CIPNM) serial electrical stimulation of motor nerves induces a short-lived temporary recovery of compound muscle action potentials (CMAPs) termed facilitation phenomenon (FP). This technique is different from other stimulation techniques published. The identification of FP suggests a major functional component in acute CIPNM. METHODS From our previous study cohort of 18 intensive care unit patients with sepsis associated CIPNM showing profound muscle weakness and low or missing CMAPs on nerve conduction studies, six patients with different severity could be followed. In a pilot sub-study we analyzed the variability of FP during follow up. Over up to 6 weeks we performed 2-6 nerve conduction studies with our novel stimulation paradigm. Motor nerves were stimulated at 0.2-0.5 Hz with 60-100 mA at 0.2-0.5 ms duration, and CMAP responses were recorded. Standard motor nerve conduction velocities (NCV) could be done when utilizing facilitated CMAPs. Needle electromyography was checked once for spontaneous activity to discover potential denervation and muscle fiber degeneration. Serum electrolytes were checked before any examination and corrected if abnormal. RESULTS In all six patients a striking variability in the magnitude and pattern of FP could be observed at each examination in the same and in different motor nerves over time. With the first stimulus most CMAPs were below 0.1 mV or absent. With slow serial pulses CMAPs could gradually recover with normal shape and near normal amplitudes. With facilitated CMAPs NCV measurements revealed low normal values. With improvement of muscle weakness subsequent tests revealed larger first CMAP amplitudes and smaller magnitudes of FP. Needle EMG showed occasional spontaneous activity in the tibialis anterior muscle. CONCLUSION In this pilot study striking variability and magnitude of FP during follow-up was a reproducible feature indicating major fluctuations of neuromuscular excitability that may improve during follow-up. FP can be assessed by generally available electrophysiological techniques, even before patients could be tested for muscle strength. Large scale prospective studies of the facilitation phenomenon in CIPNM with or without sepsis are needed to define diagnostic specificity and to better understand the still enigmatic pathophysiology. TRIAL REGISTRATION This trial was registered at the Leipzig University Medical Center in 2021 after approval by the Ethics Committee.
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Affiliation(s)
- Madona Sekhniashvili
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
- Department of Neurology of S. Khechinashvili University Clinic, Tbilisi State Medical University, Chavchavadze Ave. 33, 0179, Tbilisi, Georgia.
| | - Petra Baum
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Klaus V Toyka
- Department of Neurology, University of Würzburg, Josef Schneider Str.11, 97080, Würzburg, Germany
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2
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Terahertz Waves Enhance the Permeability of Sodium Channels. Symmetry (Basel) 2023. [DOI: 10.3390/sym15020427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
With the help of molecular dynamics simulations and an artificial sodium channel model, we corroborated that the application of terahertz stimulation at a characteristic frequency can largely increase the permeability of the sodium channel by a factor of 33.6. The mechanism is that the carboxylate groups in the filter region transfer the absorbed terahertz photon energy to the sodium ions, which increase the ions’ kinetic energy; this results in breaking the hydrated hydrogen bonding network between the hydrosphere layer of the ions and the carboxylate groups, thereby increasing their diffusion and reducing the energy barrier for them to cross the channel. This study on terahertz-driven particle transmembrane transport offers new ideas for targeted therapy of channel diseases and for developing novel integrated engineering systems in energy conversion and storage.
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3
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Engelhardt LJ, Carbon NM, Weber-Carstens S. [54/m-Muscle weakness and prolonged weaning from mechanical ventilation after peritonitis with septic shock : Preparation course anesthesiological intensive care medicine: case 29]. DIE ANAESTHESIOLOGIE 2022; 71:149-153. [PMID: 35941303 DOI: 10.1007/s00101-022-01166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Lilian Jo Engelhardt
- Klinik für Anästhesiologie m.S. operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus CVK&CCM, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
- Institut für Medizinische Informatik, Charité - Universitätsmedizin Berlin, Campus CCM, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Niklas M Carbon
- Klinik für Anästhesiologie m.S. operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus CVK&CCM, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Steffen Weber-Carstens
- Klinik für Anästhesiologie m.S. operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus CVK&CCM, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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4
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Sekhniashvili M, Bodechtel U, Toyka KV, Baum P. Temporary reversal of nerve and muscle dysfunction by serial electrical stimulation in critical illness neuromyopathy. Clin Neurophysiol 2022; 142:244-253. [DOI: 10.1016/j.clinph.2022.07.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
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5
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Rodriguez B, Branca M, Gutt‐Will M, Roth M, Söll N, Nansoz S, Cameron DR, Tankisi H, Tan SV, Bostock H, Raabe A, Schefold JC, Jakob SM, Z'Graggen WJ. Development and early diagnosis of critical illness myopathy in COVID-19 associated acute respiratory distress syndrome. J Cachexia Sarcopenia Muscle 2022; 13:1883-1895. [PMID: 35384375 PMCID: PMC9088321 DOI: 10.1002/jcsm.12989] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/02/2021] [Accepted: 03/07/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has greatly increased the incidence and clinical importance of critical illness myopathy (CIM), because it is one of the most common complications of modern intensive care medicine. Current diagnostic criteria only allow diagnosis of CIM at an advanced stage, so that patients are at risk of being overlooked, especially in early stages. To determine the frequency of CIM and to assess a recently proposed tool for early diagnosis, we have followed a cohort of COVID-19 patients with acute respiratory distress syndrome and compared the time course of muscle excitability measurements with the definite diagnosis of CIM. METHODS Adult COVID-19 patients admitted to the Intensive Care Unit of the University Hospital Bern, Switzerland requiring mechanical ventilation were recruited and examined on Days 1, 2, 5, and 10 post-intubation. Clinical examination, muscle excitability measurements, medication record, and laboratory analyses were performed on all study visits, and additionally nerve conduction studies, electromyography and muscle biopsy on Day 10. Muscle excitability data were compared with a cohort of 31 age-matched healthy subjects. Diagnosis of definite CIM was made according to the current guidelines and was based on patient history, results of clinical and electrophysiological examinations as well as muscle biopsy. RESULTS Complete data were available in 31 out of 44 recruited patients (mean [SD] age, 62.4 [9.8] years). Of these, 17 (55%) developed CIM. Muscle excitability measurements on Day 10 discriminated between patients who developed CIM and those who did not, with a diagnostic precision of 90% (AUC 0.908; 95% CI 0.799-1.000; sensitivity 1.000; specificity 0.714). On Days 1 and 2, muscle excitability parameters also discriminated between the two groups with 73% (AUC 0.734; 95% CI 0.550-0.919; sensitivity 0.562; specificity 0.857) and 82% (AUC 0.820; CI 0.652-0.903; sensitivity 0.750; specificity 0.923) diagnostic precision, respectively. All critically ill COVID-19 patients showed signs of muscle membrane depolarization compared with healthy subjects, but in patients who developed CIM muscle membrane depolarization on Days 1, 2 and 10 was more pronounced than in patients who did not develop CIM. CONCLUSIONS This study reports a 55% prevalence of definite CIM in critically ill COVID-19 patients. Furthermore, the results confirm that muscle excitability measurements may serve as an alternative method for CIM diagnosis and support its use as a tool for early diagnosis and monitoring the development of CIM.
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Affiliation(s)
- Belén Rodriguez
- Department of Neurosurgery, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | | | - Marielena Gutt‐Will
- Department of Neurosurgery, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Marianne Roth
- Department of Intensive Care Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Nicole Söll
- Department of Neurosurgery, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Sandra Nansoz
- Department of Intensive Care Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - David R. Cameron
- Department of Intensive Care Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital & Dept of Clinical MedicineAarhus UniversityAarhusDenmark
| | - S. Veronica Tan
- MRC Centre for Neuromuscular DiseasesUCL Institute of Neurology, The National Hospital for Neurology and NeurosurgeryLondonUK
| | - Hugh Bostock
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyLondonUK
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Stephan M. Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Werner J. Z'Graggen
- Department of Neurosurgery, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
- Department of Neurology, InselspitalBern University Hospital, University of BernBernSwitzerland
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6
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Diamond KB, Weisberg MD, Ng MK, Erez O, Edelstein D. COVID-19 Peripheral Neuropathy: A Report of Three Cases. Cureus 2021; 13:e18132. [PMID: 34692341 PMCID: PMC8525663 DOI: 10.7759/cureus.18132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 01/07/2023] Open
Abstract
This study includes three patients with various peripheral neuropathies after contracting coronavirus disease 2019 (COVID-19) infection, treated both conservatively and surgically. While cases of neurological complications have been described, neuropathy associated with COVID-19 is under-reported in orthopaedic literature. These patients presented with ulnar neuropathy, critical care polyneuropathy (CCP) with anterior interosseous nerve (AIN) neuropathy, and lateral femoral cutaneous nerve (LFCN) neuropathy. COVID-19 infection may be associated with peripheral neuropathy in addition to various neurological sequelae. Orthopaedic surgeons should screen patients for recent infections and evaluate the severity of the illness to assess for risk of neurological sequelae of COVID-19 infection.
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Affiliation(s)
- Keith B Diamond
- Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, USA
| | | | - Mitchell K Ng
- Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, USA
| | - Orry Erez
- Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, USA
| | - David Edelstein
- Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, USA
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7
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Goossens C, Weckx R, Derde S, Van Helleputte L, Schneidereit D, Haug M, Reischl B, Friedrich O, Van Den Bosch L, Van den Berghe G, Langouche L. Impact of prolonged sepsis on neural and muscular components of muscle contractions in a mouse model. J Cachexia Sarcopenia Muscle 2021; 12:443-455. [PMID: 33465304 PMCID: PMC8061378 DOI: 10.1002/jcsm.12668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/19/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Prolonged critically ill patients frequently develop debilitating muscle weakness that can affect both peripheral nerves and skeletal muscle. In-depth knowledge on the temporal contribution of neural and muscular components to muscle weakness is currently incomplete. METHODS We used a fluid-resuscitated, antibiotic-treated, parenterally fed murine model of prolonged (5 days) sepsis-induced muscle weakness (caecal ligation and puncture; n = 148). Electromyography (EMG) measurements were performed in two nerve-muscle complexes, combined with histological analysis of neuromuscular junction denervation, axonal degeneration, and demyelination. In situ muscle force measurements distinguished neural from muscular contribution to reduced muscle force generation. In myofibres, imaging and biomechanics were combined to evaluate myofibrillar contractile calcium sensitivity, sarcomere organization, and fibre structural properties. Myosin and actin protein content and titin gene expression were measured on the whole muscle. RESULTS Five days of sepsis resulted in increased EMG latency (P = 0.006) and decreased EMG amplitude (P < 0.0001) in the dorsal caudal tail nerve-tail complex, whereas only EMG amplitude was affected in the sciatic nerve-gastrocnemius muscle complex (P < 0.0001). Myelin sheath abnormalities (P = 0.2), axonal degeneration (number of axons; P = 0.4), and neuromuscular junction denervation (P = 0.09) were largely absent in response to sepsis, but signs of axonal swelling [higher axon area (P < 0.0001) and g-ratio (P = 0.03)] were observed. A reduction in maximal muscle force was present after indirect nerve stimulation (P = 0.007) and after direct muscle stimulation (P = 0.03). The degree of force reduction was similar with both stimulations (P = 0.2), identifying skeletal muscle, but not peripheral nerves, as the main contributor to muscle weakness. Myofibrillar calcium sensitivity of the contractile apparatus was unaffected by sepsis (P ≥ 0.6), whereas septic myofibres displayed disorganized sarcomeres (P < 0.0001) and altered myofibre axial elasticity (P < 0.0001). Septic myofibres suffered from increased rupturing in a passive stretching protocol (25% more than control myofibres; P = 0.04), which was associated with impaired myofibre active force generation (P = 0.04), linking altered myofibre integrity to function. Sepsis also caused a reduction in muscle titin gene expression (P = 0.04) and myosin and actin protein content (P = 0.05), but not the myosin-to-actin ratio (P = 0.7). CONCLUSIONS Prolonged sepsis-induced muscle weakness may predominantly be related to a disruption in myofibrillar cytoarchitectural structure, rather than to neural abnormalities.
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Affiliation(s)
- Chloë Goossens
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Ruben Weckx
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Sarah Derde
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Lawrence Van Helleputte
- Experimental Neurology and Leuven Brain Institute, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Laboratory of Neurobiology, VIB Center for Brain & Disease Research, Leuven, Belgium
| | - Dominik Schneidereit
- Institute of Medical Biotechnology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Haug
- Institute of Medical Biotechnology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Barbara Reischl
- Institute of Medical Biotechnology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Ludo Van Den Bosch
- Experimental Neurology and Leuven Brain Institute, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Laboratory of Neurobiology, VIB Center for Brain & Disease Research, Leuven, Belgium
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Lies Langouche
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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8
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Schefold JC, Wollersheim T, Grunow JJ, Luedi MM, Z'Graggen WJ, Weber-Carstens S. Muscular weakness and muscle wasting in the critically ill. J Cachexia Sarcopenia Muscle 2020; 11:1399-1412. [PMID: 32893974 PMCID: PMC7749542 DOI: 10.1002/jcsm.12620] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/10/2020] [Accepted: 08/23/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Wollersheim
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Julius J Grunow
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Werner J Z'Graggen
- Department of Neurology and Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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9
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Abstract
Critical illness polyneuropathy (CIP) along with critical illness myopathy (CIM) is a frequent condition in critically ill patients. Similar to critical illness myopathy, the exact incidence, etiology, and mechanisms of CIP are not well understood. Although decreased compound muscle action potential amplitudes may be seen in both conditions, differentiation mostly relies on sensory nerve conduction studies which require special care to perform at intensive care units. In some instances, both CIP and critical illness myopathy are observed, and this condition is called critical illness neuromyopathy. In this review, nerve conduction studies and needle electromyography for the diagnosis of CIP and differentiation of CIP from critical illness myopathy and other conditions at intensive care units are summarized.
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10
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McClafferty B, Umer I, Fye G, Kepko D, Kalayanamitra R, Shahid Z, Ramgobin D, Cai A, Groff A, Bhandari A, Aggarwal CS, Patel R, Bhatt D, Polimera H, Sahu N, Vunnam R, Golamari R, Kumar A, Jain R. Approach to critical illness myopathy and polyneuropathy in the older SARS-CoV-2 patients. J Clin Neurosci 2020; 79:241-245. [PMID: 33070904 PMCID: PMC7380205 DOI: 10.1016/j.jocn.2020.07.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/08/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
One of the major concerns of the health care community and the public surrounding the SARS-CoV-2 pandemic is the availability and use of ventilators. Unprecedented surges of patients presented to intensive care units across the country, with older adults making up a large proportion of the patient population. This paper illustrates contemporary approaches to critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and critical illness polyneuromyopathy (CIPNM) in older patients, including incidence, risk factors, mechanisms for pathology, diagnosis, contemporary treatment approaches, and outcomes. We hope that the following analysis may help educate clinicians and ultimately decrease the duration of the mechanical ventilation required by these patients, resulting in improved clinical outcomes and an increase in ventilator availability for other patients in need.
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Affiliation(s)
| | - Ibrahim Umer
- Lake Erie College of Osteopathic Medicine, United States
| | - Gary Fye
- Lake Erie College of Osteopathic Medicine, United States
| | - Douglas Kepko
- Lake Erie College of Osteopathic Medicine, United States
| | | | - Zainab Shahid
- Lake Erie College of Osteopathic Medicine, United States
| | | | - Alice Cai
- Penn State College of Medicine, United States
| | | | - Abani Bhandari
- Department of Internal Medicine, KISTMC, Tribhuvan University, Nepal, India
| | | | - Ravi Patel
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Dhirisha Bhatt
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Hyma Polimera
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Nitasa Sahu
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Ramarao Vunnam
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Reshma Golamari
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Ashutosh Kumar
- Department of Pediatrics and Neurology, Penn State Milton S. Hershey Medical Center, United States
| | - Rohit Jain
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
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11
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Li T, Liu L, Wang X. [Sepsis impairs aggregation of nicotinic acetylcholine receptors on murine skeletal muscle cell membranes by inhibiting AKT/GSK3β phosphorylation]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:1337-1343. [PMID: 31852639 DOI: 10.12122/j.issn.1673-4254.2019.11.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate the role of the protein-serine-threonine kinase (AKT)/glycogen synthase kinase 3β (GSK3β) signaling pathway in nicotinic acetylcholine receptors (nAChRs) aggregation disorder on skeletal muscle cell membranes induced by sepsis. METHODS Mouse C2C12 myoblasts were differentiated into myotubes by horse serum, and then C2C12 myotubes were randomly divided into four groups: the Sham group treated with serum from sham-operated mice, the Sepsis group treated with serum from septic mice, the Sepsis+D group treated with serum from septic mice and dimethyl sulfoxide (DMSO), the Sepsis+SB group treated with serum from septic mice and GSK3β inhibitor SB216763. Agrin was added into the cell culture to induce nAChRs aggregation before the treatment. After serum treatment for 5.5 h, the myotubes were examined for nAChRs clusters using Alexa Fluor 594-conjugated α-bungarotoxin (α- BTX). The expression levels of AKT, GSK3β and CLIP- associated protein 2 (CLASP2) and the phosphorylation of AKT, GSK3β were examined with Western blotting. The phosphorylation of CLASP2 and the interaction between CLASP2 and α-tubulin were detected with co-immunoprecipitation (Co-IP) assay. RESULTS Compared with the serum from sham-operated mice, the serum from septic mice caused significant reduction in the area and density of nAChRs clusters on C2C12 myotubes, lowered the levels of phosphorylated AKT (p-AKT) and phosphorylated GSK3β (p-GSK3β), increased the expression of phosphorylated CLASP2 (p-CLASP2), and obviously reduced the binding between CLASP2 and α-tubulin. Compared with DMSO, SB216763 significantly increased the area and density of nAChRs clusters on C2C12 myotubes treated with serum from septic mice, decreased the expression of p-CLASP2, and enhanced the interaction between CLASP2 and α-tubulin. CONCLUSIONS Septic mouse serum impairs nAChRs aggregation on C2C12 myotubes possibly by suppressing AKT/GSK3β phosphorylation to cause reduced interaction between CLASP2 and α-tubulin.
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Affiliation(s)
- Tianmei Li
- Department of Anesthesiology, First Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Li Liu
- Department of Anesthesiology, First Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Xiaobin Wang
- Department of Anesthesiology, First Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
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12
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Ren X. The architecture fusion of human motor nerve and neural network computer driven by sports. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2019. [DOI: 10.3233/jifs-179175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Xiaojian Ren
- Shandong Women’s University, Jinan, Shandong, China
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13
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Ancans G, Zentina D, Kravale Z. Pneumonia and hypercapnic respiratory failure. Breathe (Sheff) 2019; 15:e117-e121. [PMID: 31777574 PMCID: PMC6876134 DOI: 10.1183/20734735.0169-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 75-year-old woman was brought to the emergency department after she was found unconscious at her house. She had had a productive cough and fever up to 39°C for the previous 4 days. She had a past medical history of high blood pressure, paroxysmal atrial fibrillation and type 2 diabetes (without insulin therapy), and was regularly taking bisoprolol, propafenone, atorvastatin, metformin and aspirin. She was a nonsmoker and had no occupational exposures. Can you diagnose this patient presenting with pneumonia and hypercapnic respiratory failure?http://bit.ly/2zz53zO
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14
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Parry SM, Chapple LAS, Mourtzakis M. Exploring the Potential Effectiveness of Combining Optimal Nutrition With Electrical Stimulation to Maintain Muscle Health in Critical Illness: A Narrative Review. Nutr Clin Pract 2018; 33:772-789. [PMID: 30358183 DOI: 10.1002/ncp.10213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Muscle wasting occurs rapidly within days of an admission to the intensive care unit (ICU). Concomitant muscle weakness and impaired physical functioning can ensue, with lasting effects well after hospital discharge. Early physical rehabilitation is a promising intervention to minimize muscle weakness and physical dysfunction. However, there is an often a delay in commencing active functional exercises (such as sitting on the edge of bed, standing and mobilizing) due to sedation, patient alertness, and impaired ability to cooperate in the initial days of ICU admission. Therefore, there is high interest in being able to intervene early through nonvolitional exercise strategies such as electrical muscle stimulation (EMS). Muscle health characterized as the composite of muscle quantity, as well as functional and metabolic integrity, may be potentially maintained when optimal nutrition therapy is provided in complement with early physical rehabilitation in critically ill patients; however, the type, dosage, and timing of these interventions are unclear. This article explores the potential role of nutrition and EMS in maintaining muscle health in critical illness. Within this article, we will evaluate fundamental concepts of muscle wasting and evaluate the effects of EMS, as well as the effects of nutrition therapy on muscle health and the clinical and functional outcomes in critically ill patients. We will also highlight current research gaps in order to advance the field forward in this important area.
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Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Lee-Anne S Chapple
- Intensive Care Research, Royal Adelaide Hospital, South Australia, Australia
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Thabet Mahmoud A, Tawfik MAM, Abd El Naby SA, Abo El Fotoh WMM, Saleh NY, Abd El Hady NMS. Neurophysiological study of critical illness polyneuropathy and myopathy in mechanically ventilated children; additional aspects in paediatric critical illness comorbidities. Eur J Neurol 2018; 25:991-e76. [PMID: 29604150 DOI: 10.1111/ene.13649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Critical illness polyneuropathy and myopathy (CIP/CIM) is being increasingly recognized as a significant clinical problem in critically ill children especially if they have spent long periods in the intensive care unit. So the aim was to determine the frequency of CIP/CIM amongst mechanically ventilated children and to analyse the associated risk factors and drawbacks frequently encountered in this cohort. METHODS The study included 105 patients admitted to the paediatric intensive care unit who underwent mechanical ventilation for ≥7 days. These patients were screened daily for awakening. Patients with severe muscle weakness on day 7 post-awakening underwent nerve conduction studies and electromyography. Accordingly, the patients were classified as CIP/CIM patients if they had abnormal neurophysiology studies or control patients if normal neurophysiology studies were obtained. Their clinical and laboratory profiles had been recorded as well. RESULTS Overall, of 105 patients who achieved satisfactory awakening, 34 patients (32.4%) developed CIP/CIM mostly of the axonal polyneuropathy pattern (27.6%) whilst 71 control patients (67.6%) showed normal electrophysiological studies. The mean duration of mechanical ventilation was significantly longer in patients with CIP/CIM compared to control patients (P = 0.001). The study also revealed that 62.1% of our CIP/CIM patients failed weaning trials and finally died. CIP/CIM was significantly associated with decreased platelets, elevated liver enzymes and prolonged prothrombin time. Acidosis, low serum calcium and albumin levels and higher blood glucose were also found to be more significant in CIP/CIM patients compared to control patients. CONCLUSION Critically ill children frequently develop CIP/CIM, mostly of axonal polyneuropathy pattern, which compromises rehabilitation and recovery and is associated with a number of comorbidities.
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Affiliation(s)
- A Thabet Mahmoud
- Faculty of Medicine, Menoufia University Hospitals, Shebin El-Kom, Egypt
| | - M A M Tawfik
- Faculty of Medicine, Menoufia University Hospitals, Shebin El-Kom, Egypt
| | - S A Abd El Naby
- Faculty of Medicine, Menoufia University Hospitals, Shebin El-Kom, Egypt
| | - W M M Abo El Fotoh
- Faculty of Medicine, Menoufia University Hospitals, Shebin El-Kom, Egypt
| | - N Y Saleh
- Faculty of Medicine, Menoufia University Hospitals, Shebin El-Kom, Egypt
| | - N M S Abd El Hady
- Faculty of Medicine, Menoufia University Hospitals, Shebin El-Kom, Egypt
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Diniz LRL, Portella VG, da Silva Alves KS, Araújo PCDC, de Albuquerque Júnior RLC, Cavalcante de Albuquerque AA, Coelho-de-Souza AN, Leal-Cardoso JH. Electrophysiologic alterations in the excitability of the sciatic and vagus nerves during early stages of sepsis. J Pain Res 2018; 11:783-790. [PMID: 29731661 PMCID: PMC5927063 DOI: 10.2147/jpr.s144220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Nonspecific and delayed diagnosis of neurologic damage contributes to the development of neuropathies in patients with severe sepsis. The present study assessed the electrophysiologic parameters related to the excitability and conductibility of sciatic and vagus nerves during early stages of sepsis. Materials and methods Twenty-four hours after sepsis induced by cecal ligation and puncture (CLP) model, sciatic and vagus nerves of septic (CLP group) and control (sham group) rats were removed, and selected electric stimulations were applied to measure the parameters of the first and second components of the compound action potential. The first component originated from fibers with motor and sensory functions (Types Aα and Aβ fibers) with a large conduction velocity (70-120 m/s), and the second component originated from fibers (Type Aγ) with sensorial function. To evaluate the presence of sensorial alterations, the sensitivity to non-noxious mechanical stimuli was measured by using the von Frey test. Hematoxylin and eosin staining of the nerves was performed. Results We observed an increase of rheobase followed by a decrease in the first component amplitude and a higher paw withdrawal threshold in response to the application of von Frey filaments in sciatic nerves from the CLP group compared to the sham group. Differently, a decrease in rheobase and an increase in the first component amplitude of vagal C fibers from CLP group were registered. No significant morphologic alteration was observed. Conclusion Our data showed that the electrophysiologic alterations in peripheral nerves vary with the fiber type and might be identified in the first 24 h of sepsis, before clinical signs of neuromuscular disorders.
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Affiliation(s)
| | - Viviane Gomes Portella
- Department of Physiology, Superior Institute of Biomedical Sciences, State University of Ceará, Fortaleza, Brazil
| | - Kerly Shamira da Silva Alves
- Department of Physiology, Superior Institute of Biomedical Sciences, State University of Ceará, Fortaleza, Brazil
| | | | | | | | | | - José Henrique Leal-Cardoso
- Department of Physiology, Superior Institute of Biomedical Sciences, State University of Ceará, Fortaleza, Brazil
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Bear DE, Parry SM, Puthucheary ZA. Can the critically ill patient generate sufficient energy to facilitate exercise in the ICU? Curr Opin Clin Nutr Metab Care 2018; 21:110-115. [PMID: 29232263 DOI: 10.1097/mco.0000000000000446] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Trials of physical rehabilitation post critical illness have yet to deliver improved health-related quality of life in critical illness survivors. Muscle mass and strength are lost rapidly in critical illness and a proportion of patients continue to do so resulting in increased mortality and functional disability. Addressing this issue is therefore fundamental for recovery from critical illness. RECENT FINDINGS Altered mitochondrial function occurs in the critically ill and is likely to result in decreased adenosine tri-phosphate (ATP) production. Muscle contraction is a process that requires ATP. The metabolic demands of exercise are poorly understood in the ICU setting. Recent research has highlighted that there is significant heterogeneity in energy requirements between critically ill individuals undertaking the same functional activities, such as sit-to-stand. Nutrition in the critically ill is currently thought of in terms of carbohydrates, fat and protein. It may be that we need to consider nutrition in a more contextual manner such as energy generation or management of protein homeostasis. SUMMARY Current nutritional support practices in critically ill patients do not lead to improvements in physical and functional outcomes, and it may be that alternative methods of delivery or substrates are needed.
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Affiliation(s)
- Danielle E Bear
- Department of Nutrition and Dietetics
- Department of Critical Care
- Lane Fox Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Zudin A Puthucheary
- Centre for Human Health and Performance, Department of Medicine, University College London
- Department of Anaesthesia and Intensive Care, Royal Free Hospital
- Centre of Human and Aerospace Physiological Sciences, King's College London, London, UK
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