Electrophysiology Characteristic Of CIPM And The Influence To The Duration Of Mechanical Ventilation

Objective:To understand the incidence of neurological critical illness polyneuromyopathy(CIPM) in a specific group of people,to explain the electrophysiologic character of critical illness polyneuromyopathy,to increase in the diagnosis of the disease based on electrophysiological and deepen our understanding of the nature.Observating the influence of CIPM to the duration of mechanical ventilation,and explore the reasons for its impact.Methods:To utilize Denmark Keypoint 4 electromyogram instrument to make electroneurophysiology detection on twenty-seven subjects with respiratory failure who were treated with mechanical ventilation over 1 week and had difficulty in weaning from the ventilator in intensive care unit,13 male,14 female,age(69.1±16.2) years old.Electroneurophysiological examination including physical side of the median nerve,ulnar nerve,posterior tibial nerve and common peroneal nerve of nerve conduction;anterior tibial muscle,quadriceps,and deltoid abductor digiti needle EMG polar;median nerve of the F wave;ulnar nerve of the repetitive nerve stimulation(RNS);limb sympathetic skin response(SSR);under the limbs evoked potential(SEP);blink reflex(BR).To record mechanical ventilation time of CIPM and non-CIPM,at the same time to compare their detection of the phrenic nerve conduction.Results:In 27 cases of patients with nerve conduction and electromyography testing 13 were diagnosed CIPM.The incidence is about 53%(13/27),in which one subtype of critical illness polyneuropathy(CIP) in patients with 10 cases and critical illness myopathy(CIM) in patients with three cases.10 cases were detected in patients with CIP had 40 neurons,each case has two or more nerve compound muscle action potential(CMAP) and sensory nerve action potential(SNAP) amplitude lower end of motor nerve latency(DML) or less normal,and all normal nerve conduction velocity;At the same time testing the 40 muscles,25 neurogenic damage prompted. CIM detected three cases of the 12 patients with nerve,SNAP amplitude and nerve conduction velocity(NCV) were normal,eight of which reduce nerve CMAP amplitude;6 of 12 muscle show myogenic damage,mainly in the proximal muscle damage.In CIPM patients sympathetic skin response(SSR) did not lead to positive waveform.The occurrence of F wave in 3 cases of patients with CIP and 2 cases of patients with CIM reduce,and conduction velocity were normal.CIPM all patients with RNS,SEP and BR testing were normal.The patients with CIPM compound action potential amplitude of the diaphragm(diaphragmatic compound muscle action potential,DCMAP) reduced than non-CIPM was significantly(0.23±0.11 vs 0.35±0.13,P = 0.018),the difference was statistically significant.Their distal motor latency phrenic nerve(phrenic distal motor latencies,PDML) had no significant difference (7.67±1.27 vs 7.39±1.23,P = 0.562).Comparison of CIP and non-CIP group of patients with the phrenic nerve conduction in patients DCMAP was statistically significant difference(0.22±0.21 vs 0.34±0.12,P = 0.024),while no difference PDML in two groups(7.82±1.41 vs 7.35±1.13,P = 0.347).The median duration of mechanical ventilation(quartile interval) in CIPM patients were 30.0(22.5) d,and was significantly longer(U=20.0,P＜0.01) than non-CIPM 14.5(8.5) d.Analysis of the subgroup of patients with CIP group the median duration of mechanical ventilation and quartile range of 30.0(19.0) d,more than non-CIP patients 15.0(10.5) d was significantly longer(U= 30.0,P＜0.01).Conclusion:CIPM is the more common neurological complications in patients with respiratory failure mechanical ventilation over 1 week in ICU.Neural electrophysiological testing is an effective means of CIPM.In CIPM conventional electrophysiological examination of patients is mainly expressed in compound muscle action potential and(or) sensory nerve action potential amplitude reduction,while the normal NCV.All CIPM patients have abnormal SSR and there are no central nervous system and neuromuscular junction damage.Diaphragm and(or) phrenic nerve damage in patients with CIPM,which might be the direct cause of the time offiine.