Chest
Volume 99, Issue 1, January 1991, Pages 176-184
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Peripheral Nerve Function in Sepsis and Multiple Organ Failure

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Forty-three patients who had sepsis and multiple organ failure (critical illness) were studied prospectively to determine the incidence and severity of peripheral nerve function and to correlate such function with a number of variables. Electrophysiologic studies indicated a primary axonal degeneration of motor and sensory fibers in 30 (70 percent). Fifteen (30 percent) had the clinical signs of difficulty in weaning from assisted ventilation, weakness of limb muscles, and reduced or absent deep tendon reflexes. Full recovery from the polyneuropathy occurred among the 23 (53 percent) who survived, except three who had a very severe polyneuropathy. A peripheral nerve function index, computed from electrophysiologic measurements, showed statistically significant (p<0.01) negative correlations with the time in the critical care unit, and the serum glucose value; the serum albumin level showed a positive correlation. Multiple regression analyses indicated all three factors accounted for 47 percent (r2 = 0.4678) of all potential variables. In a separate analysis, the nerve function index correlated with the amplitude of the diaphragm compound muscle action potential (p<0.01). The results were consistent with the polyneuropathy being due to the same mechanisms that are currently postulated to cause dysfunction in this syndrome of other organ systems (including the neuromuscular respiratory system). (Chest 1991; 99:176–84)

Section snippets

Definition of Patients and Entry Into the Study

Our retrospective studies6,13, 14, 15 were completed in 1983. This prospective study was approved by the Ethics Committee of the University of Western Ontario. During 14 months, 1,167 patients were admitted to the Victoria Hospital critical care unit. Three hundred and twenty-four were in the unit for longer than five days, a group which we believe to be at risk of developing sepsis and multiple organ failure. From this group, patients were entered who met the following criteria; (1) had

RESULTS

The 43 patients comprised 22 men and 21 women of mean age 64 (21 to 78) years. They presented with a variety of primary conditions (Table 1). At a mean of 28 (5 to 89) days, sepsis and multiple organ failure (Table 2) were first identified. The nerve function index was determined at this time and was abnormal in 30 patients, an incidence of 70 percent. The spread of abnormalities was relatively uniform, from the most severe neuropathy at 35 percent of normal function, to the least severe at 79

DISCUSSION

During the 14-month period of this prospective study, 43 patients were identified in our critical care unit who had sepsis and multiple organ failure and met entry criteria. This identification occurred at 28 (5 to 89) days after admission to the unit. The incidence of the polyneuropathy was 70 percent. However, due to the attendant endotracheal tube and the lingering effects of septic encephalopathy, the clinical examination to detect polyneuropathy was often unreliable. Thus, only half (15)

ACKNOWLEDGMENTS

We are grateful to Miss Betsy Toth, secretary, Mr. Anthony Parkes and Mrs. Deborah Laverty, electromyography technologists, and personnel in the Critical Care Unit.

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