Critical Illness Polyneuropathy: Case Report and Update

Abstract

Asthenia is a manifestation commonly found in critically ill patients hospitalized in an intensive care unit. In addition to the hard weaning from invasive mechanical ventilation, it is essential to recognize Critical Patient’s Polyneuropathy (CPP). Case Report: JCD, 63 years old, white, single, obese (BMI> 40), type II diabetic controlled with diet and Metformin 2g / day, mild hypertension, with hyperuricemia (gout). Former smoker and social drinker. A clinic of severe abdominal pain, in bar type, appeared on the upper region of the abdomen on 07/07/2018, with a diagnostic hypothesis of urolithiasis and urinary infection. He was admitted on 10/07/2018 with an abdominal septic shock / cholecystitis. He remained on mechanical ventilation and use of amines for a long time, was tracheostomized and managed to decanulate. During this period, he developed ARDS lung, acute dialysis renal failure (recovered renal function), drug hepatitis and critical patient’s polyneuropathy. Discharge from ICU on 28/09/2018. The examination reveals tetraparesis with a predominance of the distal, brachial and crural thirds; styloradial and flexor reflexes of the left hypoactive fingers, patellar hyporeflexia, abolished aquileus; superficial sensitivity: thermal and painful tactile hypoesthesia with paresthesia on the feet soles; profound sensitivity: proprioceptive hypoesthesia and hypopalesthesia in the distal third of the 4 limbs; in addition to flaccid paraparetic gait. Lumbar puncture, ENMG and biopsy of the sural nerve. In the CSF, there was an absence of leukocytes, normal glucose and 20mg / dL proteins.The ENMG showed axonal motor sensitive polyneuropathy, with decreased potential amplitudes. Discussion: Critical Patient’s Polyneuropathy is a predominantly motor condition, however, related to sensitive, symmetrical and acute impairment associated with exaggerated systemic inflammatory response syndrome (SIRS), which mostly occurs in cases of sepsis. There is widespread asthenia and difficulty in weaning from invasive mechanical ventilation as the two peculiarities sine qua non for the identification of patients with CPP. The diagnosis of CPP is by exclusion. Electroneuromyography, in turn, is defined as the gold standard exam. Conclusion: Despite its occurrence, elements that are objectively related to its pathophysiology remain hidden. For this reason, the importance of further studies regarding the risk factors and diagnosis of CPP is reiterated in order to optimize the identification and the control of the severity of the affected patients.