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Author Topic: ICU Neuropathy  (Read 10454 times)

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yogenbhatt1

  • Yogen Bhatt, Mumbai, India
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ICU Neuropathy
« on: March 26, 2008, 01:25:20 PM »
I heard a new terminology. ICU Neuroptahy. Can some one enlighten me? Retrospectively I recollect a patient, who had gone in septicaemia, post hystrectomy due to sigmoid colon injury, and on venti with multi organ failure. Though she was out in about 10 days, she took her own sweet time, two months, to start moving her muscles. She had no movements, or responce, what so ever. Very gradually she improved and went home. But, since she was not responding to any stimuli, every one labled her brain dead. She did not recollect any event in those two months, nor did she recognise any one, who was treating her every day. She only remebered me, as I saw her almost 5 times every day.
Yes, this takes us back to septicaemia, which is a topic on itself.
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jafo1964

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Re: ICU Neuropathy
« Reply #1 on: March 27, 2008, 02:53:00 AM »
Critical Illness Neuropathy and Critical Illness Myopathy are the more accepted terms

Occur in ICU patients ventilated for long duration esp septicaemia patients

Risk factors include apart from critical illness the use of muscle relaxants and steroids.

Among muscle relaxants Pancuronium and Vecuronium most commonly incriminated. Has to do with the active metabolites of these agents like 6 Des-acetyl Vecuronium

Presents as delayed neuromuscular recovery, difficulty to wean and ventilator dependance

Recommendations include
1. Do not paralyze patients on ventilator wherever possible
2. Avoid Vec, use Atra, cisatra or Roc instead
3. Better to sedate patient than paralyze
4. Avoid steroids without definitive indication
5. When using relaxants, allow for periods of recovery from relaxants

If i have missed a trick or two, hopefully somebody will fill it in

Regs & have a nice day
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yogenbhatt1

  • Yogen Bhatt, Mumbai, India
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Re: ICU Neuropathy
« Reply #2 on: March 27, 2008, 01:13:20 PM »
Good set of tips as usual from you. Thanks a lot.
Unfortunately, the patients in ICU belongs to physicians. Though I personally prefer to sedate a pt with Buprenorphin, which knocks off the centre, the physicians are more fond of vec or Medaz.
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frontier

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Re: ICU Neuropathy
« Reply #3 on: April 07, 2008, 10:33:09 PM »
hi all,
        even midazolam or other benzodiazepines & propofol are related to critical illness  MYOPATHY.electrolyte imbalances like hypo/hyperkalemia/hypermagnesemia /hypophosphatemia etc to be blamed for myopathy/unmasked myesthenia & rhabdomyolysis due to any cause can lead to myopaties too/regards
« Last Edit: April 10, 2008, 12:06:57 AM by frontier »
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