Critical-illness-Polyneuropathie

Zusammenfassung

Die Critical-illness-Polyneuropathie stellt eine häufige neurologische Komplikation beim Intensivpatienten dar. Klinisch resultieren muskuläre Schwächen und Atrophien, die zu verzögerter Entwöhnung vom Respirator und Verlängerung der neuromuskulären Rehabilitation führen. Als ursächlich wird die septische Entzündungsreaktion (SIRS) angesehen; die pathogenetischen Mechanismen sind im Einzelnen nicht geklärt. Die Critical-illness-Polyneuropathie verläuft monophasisch und selbstlimitierend, d. h. sie bildet sich nach Beendigung der Intensivbehandlung spontan zurück. Die Diagnose wird elektrophysiologisch gestellt; die Abgrenzung gegenüber einer Myopathie gelingt häufig nur durch eine Biopsie. Die Prognose der CIP ist bei leichten Verläufen gut, schwere Verläufe können lebenslange neuromuskuläre Defizite hinterlassen.

Abstract

Critical illness polyneuropathy is a frequent neurologic complication in the ICU. Clinically, muscular weakness and atrophy are characteristic features leading to failure of weaning from the respirator and causing the need for prolonged neuromuscular rehabilitation. Most authors regard the systemic inflammatory response syndrome (SIRS) as the cause of CIP; the exact pathogenic mechanisms, however, are far from clear. The course of critical illness polyneuropathy is monophasic and self-limiting. The diagnosis is made by means of electrophysiology. Differentiation against myopathy is possible only by biopsy in most instances. Prognosis of critical illness polyneuropathy is good in minor cases. In patients with severe CIP, neurological deficits may persist during life-time with the result of reduced quality of life and restrictions in autonomy and participation.

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