Critical illness myoneuropathy, true is?
|A||Diaphragm atrophy due to prolonged mechanical ventilation|
|B||Cranial nerves more commonly involved than peripheral nerves|
|C||Progressive demyelination and inflammation of peripheral nerve|
Diaphragm atrophy due to prolonged mechanical ventilation
(Ref: Harrison 18th edition, Page 2261&3507)
1). Critically ill patients, especially those with sepsis, frequently develop muscle wasting, often in the face of seemingly adequate nutritional support.
2). It is a catabolic myopathy brought about as a result of multiple factors, including elevated cortisol and catecholamine release and other circulating factors induced by the SIRS.
3). In this syndrome, known as cachectic myopathy, serum creatine kinase levels and electromyography (EMG) are normal. Muscle biopsy shows type II fiber atrophy.
4). Panfascicular muscle fiber necrosis may also occur in the setting of profound sepsis.
5). This so-called septic myopathy is characterized clinically by weakness progressing to a profound level over just a few days.
6). There may be associated elevations in serum creatine kinase and urine myoglobin. Both EMG and muscle biopsy may be normal initially but eventually show abnormal spontaneous activity and panfascicular necrosis with an accompanying inflammatory reaction.
7). Both of these myopathic syndromes may be considered under the broader heading of critical illness myopathy.