Neuromuscular electrophysiological disorders and muscle atrophy in mechanically-ventilated traumatic brain injury patients: New insights from a prospective observational study

作者：Silva Paulo Eugenio^*; Maldaner Vinicius; Vieira Luciana; de Carvalho Karina Livino; Gomes Hedian; Melo Priscilla; Babault Nicolas; Cipriano Gerson Jr; Quagliotti Durigan Joao Luiz

来源：Journal of Critical Care, 2018, 44: 87-94.

DOI：10.1016/j.jcrc.2017.10.026

• Chronaxie
• Critical illness polyneuropathy
• Intensive care unit-acquired weakness
• Neuromuscular disorder
• Neuromuscular electrical stimulation
• Rehabilitation

Purpose: It is unclear whether the muscular changes in mechanically-ventilated traumatic brain injury patients (TBI) are only associated with disuse or additionally to neuromuscular electrophysiological disorders (NED). The correlation between muscle atrophy and NED may affect functional outcomes and rehabilitation programs significantly.
Material and methods: An observational study was performed to investigate the presence of NED and muscle atrophy in TBI patients undergoing mechanical ventilation. NED was diagnosed by the stimulus electrodiagnosis test when chronaxie was >= 1000 mu s. The muscle structure (thickness and echogenicity) was assessed by B-mode ultrasound. Tibialis anterior (TA), rectus femoris (RF), and biceps brachialis (BB) muscles were analyzed. Patients were followed from the first day of admission in the intensive care unit (ICU) to the fourteenth day.
Results: Twenty-two patients were analyzed. An increase of 48% in NED from day 1 to day 14 was detected in TA (p = 0.004). All muscles presented a significant decrease in thickness (similar to 18%, p < 0.05), but echogenicity increased only in TA (19%), p < 0.01 and RF (23%), p < 0.01.
Conclusions: Mechanically-ventilated patients with TBI developed NED in addition to changes inmuscle structure during their stay in the ICU.

• 出版日期2018-4