Elsevier

Journal of Critical Care

Volume 44, April 2018, Pages 87-94
Journal of Critical Care

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

https://doi.org/10.1016/j.jcrc.2017.10.026Get rights and content
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Highlights

  • Mechanically-ventilated TBI patients can present NED in addition to widespread muscle atrophy.

  • Tibialis Anterior had the highest incidence of NED compared to rectus femoris and biceps brachialis.

  • Ultrasound assessment associated to SET can be important for monitoring patient’s progress and for guiding more specific electrophysiological exams.

Abstract

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 μs. 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 (~ 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 in muscle structure during their stay in the ICU.

Abbreviations

APACHE II
Acute Physiology and Chronic Health Evaluation II
BB
biceps brachialis
DMS
direct muscle stimulation
ICU
intensive care unit
ICUAW
intensive care unit-acquired weakness
μs
microseconds
NCS
Nerve conduction study
NED
Neuromuscular electrophysiological disorders
NMES
neuromuscular electrical stimulation
RF
Rectus femoris
SET
stimulus electrodiagnosis test
TA
tibialis anterior
TBI
traumatic brain injury

Keywords

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

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