Critical Illness Polyneuromyopathy and Physical Rehabilitation

¹Physical Medicine and Functional Rehabilitation service-UHC Ibn Rochd Casablanca, Morocco ²Intensive Care Unit, Hospital August 20-UHC Ibn Rochd Casablanca, Morocco

^*Corresponding Author: Lazraq Mohamed, Physician, Anesthesia-Reanimation, Hospital August 20, 1953, Ibn Rochd Hospital of Casablanca, Morocco.

Received: September 12, 2019 Published: September 27, 2019

ABSTRACT

Critical illness polyneuropathy occurs in patients with severe acute aggression that is life-threatening and is managed in an intensive care unit. It most often affects patients free from any previous neurological pathology. The two main risk factors are severe multi-organ failure and muscle immobilization. This complication can be prevented by early passive and active rehabilitation programs even in ventilated patients.

INTRODUCTION

Critical illness polyneuropathy is a frequent complication of critical illness, acutely and primarily affecting the motor and sensory axons. This disorder occurs in patients with severe acute aggression that is life-threatening and is managed in intensive care unit. It most often affects patients free from any previous neurological pathology. The two main risk factors are severe multi-organ failure and muscle immobilization. This complication can be prevented by early passive and active rehabilitation programs even in ventilated patients. In this paper, we report a case of a patient who suffered from Critical illness polyneuropathy with good recovery after physical rehabilitation.

CASE STUDY

This is a 51-year-old patient, followed for asthma since childhood, who was admitted to intensive care for severe acute asthma complicated by septic shock with multiorgan failure. The patient stayed for 2 months in the intensive care unit. At its exit, the patient was sent to us for management of his critical illness polyneuropathy. On examination: Tetraparesis with respect to face muscles; a decrease of osteo-tendinous reflexes, without the sensory disorder, Muscle Strength Grading: superior limbs rated at 2/5 and inferior at less than 1/5. The patient has benefited from a functional rehabilitation protocol based on passive mobilization, assisted-active and then active, respiratory physiotherapy, verticalization, management of decubitus complications and muscle strengthening techniques. Two months later, our patient was walking with Muscle Strength Grading overall to 4/5 for the 4 members.

DISCUSSION

In intensive care, many factors contribute to the development of critical illness polyneuropathies, such as inflammatory reactions, multiorgan failure, corticosteroids and prolonged mechanical ventilation [1, 2]. Patient's deep sedation, and more particularly bed rest and immobilization, are also associated with the occurrence of these neuromuscular disorders [3]. Functional rehabilitation plays an essential role in the prevention and management of critical illness neuromyopathy, which can compromise the physical and functional evolution and quality of life of patients in the short and long term. Early rehabilitation helps to prevent peripheral muscle deconditioning, joint stiffness and initiates retraining of skeletal muscles. It also makes a possible modification of pulmonary volumes distribution by posture changing during rehabilitation’s exercises, favoring bronchial decluttering and communication [4,5]. Despite a limited number of studies on rehabilitation in intensive care, recent studies with a large sample show a real impact of length of stay in intensive care, duration of mechanical ventilation, muscle recovery and recovery of autonomy [6].

CONCLUSION

The value of early rehabilitation seems essential to minimize the risk of definitive disability. However, there is still a lack of studies and work to evaluate potential preventive and curative effects of a specific rehabilitation protocol in patients with neuromuscular complications after intensive care hospitalization.

REFERENCES

1. Bolton CF (2005) Neuromuscular manifestations of critical illness. Muscle Nerve 32(2): 140-163.

2. Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, et al. (2007) Neuromuscular dysfunction acquired in critical illness: A systematic review. Intensive Care Med 33(11): 1876-1891.

3. Sharshar T (2008) Neuromyopathies acquises en reanimation, délirium et sedation en reanimation. Ann Fr Reanim 27(7-8): 617-622.

4. De Jonghe B, Outin H, Lacherade JC, Sharshar T (2008) Consequences respiratoires de la neuromyopathie de reanimation. Reanimation 17(7): 625-630.

5. Guerin C, Burle JF (2015) Rehabilitation precoce en reanimation. C’est possible. Reanimation 24(Suppl 2): 371-378.

6. Medrinal C (2012) La rehabilitation precoce en reanimation: Quels resultats?? Kinésitherapie la Revue 12(127): 29-38.

Copyright: Mohamed L, et al. ©2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation: Mohamed L (2019). Critical Illness Polyneuromyopathy and Physical Rehabilitation. Medical Research 1(1): 3.