Skip to main content

Advertisement

SpringerLink
Log in

Intensive care unit-acquired neuromyopathy and corticosteroids in survivors of persistent ARDS

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objectives

To determine the incidence and outcomes of intensive care unit-acquired neuromyopathy and to investigate the role of methylprednisolone in survivors of persistent acute lung injury.

Design

Secondary analysis of completed randomized placebo-controlled trial.

Setting

Twenty-five hospitals in the NHLBI ARDS Network.

Patients and participants

Patients enrolled in the ARDS Network study of methylprednisolone versus placebo for persistent ARDS who survived 60 days or to hospital discharge.

Measurements and results

One hundred and twenty-eight study patients survived 60 days. Forty-three (34%) of these patients had evidence by chart review of ICU-acquired neuromyopathy, which was associated with prolonged mechanical ventilation, return to mechanical ventilation, and delayed return to home after critical illness. Treatment with methylprednisolone was not significantly associated with an increase in risk of neuromyopathy (OR 1.5; 95% CI 0.7–3.2).

Conclusions

ICU-acquired-neuromyopathy is common among survivors of persistent ARDS and is associated with poorer clinical outcomes. We did not find a significant association between methylprednisolone treatment and neuromyopathy. Limitations of this study preclude definitive conclusions about the causal relationship between corticosteroids and ICU-acquired neuromuscular dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, Cerf C, Renaud E, Mesrati F, Carlet J, Raphael JC, Outin H, Bastuji-Garin S (2002) Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 288:2859–2867

    Article  PubMed  Google Scholar 

  2. de Letter MA, Schmitz PI, Visser LH, Verheul FA, Schellens RL, Op de Coul DA, van der Meche FG (2001) Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med 29:2281–2286

    Article  PubMed  Google Scholar 

  3. Leijten FS, De Weerd AW, Poortvliet DC, De Ridder VA, Ulrich C, Harink-De Weerd JE (1996) Critical illness polyneuropathy in multiple organ dysfunction syndrome and weaning from the ventilator. Intensive Care Med 22:856–861

    Article  PubMed  CAS  Google Scholar 

  4. Berek K, Margreiter J, Willeit J, Berek A, Schmutzhard E, Mutz NJ (1996) Polyneuropathies in critically ill patients: a prospective evaluation. Intensive Care Med 22:849–855

    Article  PubMed  CAS  Google Scholar 

  5. Bercker S, Weber-Carstens S, Deja M, Grimm C, Wolf S, Behse F, Busch T, Falke KJ, Kaisers U (2005) Critical illness polyneuropathy and myopathy in patients with acute respiratory distress syndrome. Crit Care Med 33:711–715

    Article  PubMed  Google Scholar 

  6. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693

    Article  PubMed  Google Scholar 

  7. McHugh LG, Milberg JA, Whitcomb ME, Schoene RB, Maunder RJ, Hudson LD (1994) Recovery of function in survivors of the acute respiratory distress syndrome. Am J Respir Crit Care Med 150:90–94

    PubMed  CAS  Google Scholar 

  8. Angus DC, Musthafa AA, Clermont G, Griffin MF, Linde-Zwirble WT, Dremsizov TT, Pinsky MR (2001) Quality-adjusted survival in the first year after the acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1389–1394

    PubMed  CAS  Google Scholar 

  9. Weinert CR, Gross CR, Kangas JR, Bury CL, Marinelli WA (1997) Health-related quality of life after acute lung injury. Am J Respir Crit Care Med 156:1120–1128

    PubMed  CAS  Google Scholar 

  10. Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP (1999) Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 281:354–360

    Article  PubMed  CAS  Google Scholar 

  11. Amaya-Villar R, Garnacho-Montero J, Garcia-Garmendia JL, Madrazo-Osuna J, Garnacho-Montero MC, Luque R, Ortiz-Leyba C (2005) Steroid-induced myopathy in patients intubated due to exacerbation of chronic obstructive pulmonary disease. Intensive Care Med 31:157–161

    Article  PubMed  Google Scholar 

  12. Campellone JV, Lacomis D, Kramer DJ, Van Cott AC, Giuliani MJ (1998) Acute myopathy after liver transplantation. Neurology 50:46–53

    PubMed  CAS  Google Scholar 

  13. Coakley JH, Nagendran K, Yarwood GD, Honavar M, Hinds CJ (1998) Patterns of neurophysiological abnormality in prolonged critical illness. Intensive Care Med 24:801–807

    Article  PubMed  CAS  Google Scholar 

  14. Garnacho-Montero J, Madrazo-Osuna J, Garcia-Garmendia JL, Ortiz-Leyba C, Jimenez-Jimenez FJ, Barrero-Almodovar A, Garnacho-Montero MC, Moyano-Del-Estad MR (2001) Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med 27:1288–1296

    Article  PubMed  CAS  Google Scholar 

  15. Lefaucheur JP, Nordine T, Rodriguez P, Brochard L (2006) Origin of ICU acquired paresis determined by direct muscle stimulation. J Neurol Neurosurg Psychiatry 77:500–506

    Article  PubMed  Google Scholar 

  16. Rudis MI, Guslits BJ, Peterson EL, Hathaway SJ, Angus E, Beis S, Zarowitz BJ (1996) Economic impact of prolonged motor weakness complicating neuromuscular blockade in the intensive care unit. Crit Care Med 24:1749–1756

    Article  PubMed  CAS  Google Scholar 

  17. Thiele RI, Jakob H, Hund E, Tantzky S, Keller S, Kamler M, Herold U, Hagl S (2000) Sepsis and catecholamine support are the major risk factors for critical illness polyneuropathy after open heart surgery. Thorac Cardiovasc Surg 48:145–150

    Article  PubMed  CAS  Google Scholar 

  18. Friedrich O (2006) Critical illness myopathy: what is happening? Curr Opin Clin Nutr Metab Care 9:403–409

    Article  PubMed  CAS  Google Scholar 

  19. Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM (2007) Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 33:1876–1891

    Article  PubMed  Google Scholar 

  20. Horinouchi H, Kumamoto T, Kimura N, Ueyama H, Tsuda T (2005) Myosin loss in denervated rat soleus muscle after dexamethasone treatment. Pathobiology 72:108–116

    Article  PubMed  CAS  Google Scholar 

  21. Massa R, Carpenter S, Holland P, Karpati G (1992) Loss and renewal of thick myofilaments in glucocorticoid-treated rat soleus after denervation and reinnervation. Muscle Nerve 15:1290–1298

    Article  PubMed  CAS  Google Scholar 

  22. Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, Thompson BT, Ancukiewicz M (2006) Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 354:1671–1684

    Article  PubMed  CAS  Google Scholar 

  23. Hough CL, Steinberg KP, Goodman RB, Thompson BT, Hudson LD (2006) Incidence, risk factors, serum markers, and outcomes of neuromyopathy in persistent ARDS. Am J Respir Crit Care Med 3:A570

    Google Scholar 

  24. NCI (1999) Common toxicity criteria. http://ctepcancergov/forms/CTCv20_4-30-992pdf

  25. Hough CL (2006) Neuromuscular sequelae in survivors of acute lung injury. Clin Chest Med 27:691–703

    Article  PubMed  Google Scholar 

  26. Witt NJ, Zochodne DW, Bolton CF, Grand’Maison F, Wells G, Young GB, Sibbald WJ (1991) Peripheral nerve function in sepsis and multiple organ failure. Chest 99:176–184

    Article  PubMed  CAS  Google Scholar 

  27. Garnacho-Montero J, Amaya-Villar R, Garcia-Garmendia JL, Madrazo-Osuna J, Ortiz-Leyba C (2005) Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med 33:349–354

    Article  PubMed  Google Scholar 

  28. De Jonghe B, Bastuji-Garin S, Sharshar T, Outin H, Brochard L (2004) Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med 30:1117–1121

    Article  PubMed  Google Scholar 

  29. Van den Berghe G, Schoonheydt K, Becx P, Bruyninckx F, Wouters PJ (2005) Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology 64:1348–1353

    PubMed  Google Scholar 

  30. Ali NA, O’Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, Almoosa K, Hejal R, Wolf KM, Lemeshow S, Connors AF Jr, Marsh CB (2008) Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med 178:261–268

    Article  PubMed  Google Scholar 

  31. Latronico N, Guarneri B, Alongi S, Bussi G, Candiani A (1999) Acute neuromuscular respiratory failure after ICU discharge. Report of five patients. Intensive Care Med 25:1302–1306

    Article  PubMed  CAS  Google Scholar 

  32. Rich MM, Pinter MJ, Kraner SD, Barchi RL (1998) Loss of electrical excitability in an animal model of acute quadriplegic myopathy. Ann Neurol 43:171–179

    Article  PubMed  CAS  Google Scholar 

  33. Hermans G, Wilmer A, Meersseman W, Milants I, Wouters PJ, Bobbaers H, Bruyninckx F, Van den Berghe G (2007) Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. Am J Respir Crit Care Med 175:480–489

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Support for this work was provided by the Francis Family Foundation and the National Heart Lung and Blood Institute through the ARDS Network and Mentored Career Development Award (K23HL74294).

Author information

Authors and Affiliations

  1. Department of Medicine and The NHLBI ARDS Network, University of Washington, 325 Ninth Avenue, Mailstop 359762, Seattle, WA, 98104, USA

    Catherine L. Hough, Kenneth P. Steinberg & Leonard D. Hudson

  2. Department of Medicine and The NHLBI ARDS Network, Massachusetts General Hospital, Boston, MA, USA

    B. Taylor Thompson

  3. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Gordon D. Rubenfeld

Authors
  1. Catherine L. Hough
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth P. Steinberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Taylor Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gordon D. Rubenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leonard D. Hudson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine L. Hough.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-008-1305-3.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hough, C.L., Steinberg, K.P., Taylor Thompson, B. et al. Intensive care unit-acquired neuromyopathy and corticosteroids in survivors of persistent ARDS. Intensive Care Med 35, 63–68 (2009). https://doi.org/10.1007/s00134-008-1304-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-008-1304-4

Keywords

Search

Navigation