Disclosures: Chul Jung: No financial relationships or conflicts of interest

Objective: To investigate the prognostic value of a simplified diagnosis of critical illness polyneuropathy (CIP) in patients with prolonged mechanical ventilation and identify clinical characteristics and risk factors of CIP.

Design: Prospective cohort study. Setting : Surgical intensive care unit (SICU) in tertiary care hospital. Participants : Forty-one adults with prolonged (≥3 weeks) mechanical ventilation in SICU were recruited between November 2016 and May 2018.

Interventions: After 3 weeks of mechanical ventilation, nerve conduction study (NCS) of unilateral peroneal, tibial, sural, ulnar (both motor and sensory), and phrenic nerve was performed. The muscle strength of extremities was also graded using the Medical Research Council (MRC) scale.

Main Outcome Measures: Prognosis was assessed using ventilator-free days at day 60 (VFDs-60), ICU-free days at day 60 (IFDs-60), and ICU mortality. Logistic regression identified associations between clinical characteristics and CIP diagnosis.

Results: According to simplified criteria, CIP was diagnosed if the MRC sum score was lower than 48, and amplitudes of both compound muscle action potential (CMAP) in the tibial nerve and sensory nerve action potential (SNAP) in the sural nerve were decreased. Eleven patients were diagnosed with CIP. CIP was significantly associated with 0 VFDs-60 (p=0.029) and 0 IFDs-60 (p=0.006), but not associated with ICU mortality (p=0.247). Days of corticosteroid administration before NCS (OR:1.141, CI:1.005-1.294; p=0.041) and severe malnutrition status (OR:240.554, CI:4.333-13355.084; p=0.007) significantly increased risk of CIP. Age, diabetes, chronic kidney disease, and chemotherapy history showed no significant differences. Low amplitude of phrenic nerve CMAP (≤0.2mV) was associated with CIP (p=0.003) but was not associated with VFDs-60 (p=0.151). Conclusions: These results suggest a simplified diagnosis of CIP has significant prognostic value for patients with prolonged mechanical ventilation, especially those severely malnourished or receiving corticosteroids. Considering difficulty to perform standard NCS in an ICU setting, it is worth applying simplified criteria to critically ill patients in ICU.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/simplified-diagnosis-of-critical-illness-polyneuropathy-in-patients-with-prolonged-mechanical-ventilation/