Critical illness polyneuropathy and myopathy in pediatric intensive care: A review

OBJECTIVE: To review the medical literature on critical illness polyneuropathy and myopathy in childhood. DATA SOURCE: Medline and EMBASE were searched using the following terms: critical illness (neuropathy, polyneuropathy, and myopathy), critical care (neuropathy, polyneuropathy, and myopathy), acute myopathy, acute necrotizing myopathy, children, and pediatric. The references listed in publications thus identified were also reviewed. STUDY SELECTION AND DATA EXTRACTION: All studies relating to pediatric critical illness polyneuropathy and myopathy were included. The adult literature was also reviewed as to the current understanding of critical illness polyneuropathy and myopathy. DATA SYNTHESIS: Critical illness polyneuropathy and critical illness myopathy are well recognized in adults, in whom they commonly cause generalized weakness and muscle wasting, with failure to wean from mechanical ventilation. Critical illness polyneuropathy and critical illness myopathy are reported in 32-100% of critically ill adult patients ventilated for >3 days. There is significant clinical and neurophysiologic overlap between the two conditions, such that the term critical illness polyneuropathy and myopathy (CIPNM) is often used. Critical illness polyneuropathy and critical illness myopathy have only occasionally been reported in childhood, and little is known of their prevalence or clinical significance in this population. This article summarizes the pediatric literature on critical illness polyneuropathy and critical illness myopathy and highlights areas for future research in critically ill children. CONCLUSIONS: Critical illness polyneuropathy and myopathy may cause significant morbidity in critically ill children. These conditions seem to be clinically and electrophysiologically similar in children and adults, but prospective studies of these entities are required to better characterize their frequency, natural history, and clinical significance in pediatric practice.