PDF(Pubmed)
Abstract：
Intensive Care Unit (ICU)-Acquired Weakness (ICU-AW) is a generalized muscle weakness that is clinically detected in critical patients and has no plausible etiology other than critical illness. ICU-AW is uncommon in patients undergoing orthotopic liver transplantation (OLT). Our report sheds light on the highest number of ICU-AW cases observed in a single center on OLT patients with early allograft dysfunction. Out of 282 patients who underwent OLT from January 2015 to June 2023, 7 (2.5%) developed generalized muscle weakness in the ICU and underwent neurophysiological investigations. The neurologic examination showed preserved extraocular, flaccid quadriplegia with the absence of deep tendon reflexes in all patients. Neurophysiological studies, including electromyography and nerve conduction studies, showed abnormalities with fibrillation potentials and the rapid recruitment of small polyphasic motor units in the examined muscles, as well as a reduced amplitude of the compound muscle action potential and sensory nerve action potential, with an absence of demyelinating features. Pre-transplant clinical status was critical in all patients. During ICU stay, early allograft dysfunction, acute kidney injury, prolonged mechanical ventilation, sepsis, hyperglycemia, and high blood transfusions were observed in all patients. Two patients were retransplanted. Five patients were alive at 90 days; two patients died. In non-cooperative OLT patients, neurophysiological investigations are essential for the diagnosis of ICU-AW. In this setting, the high number of red blood cell transfusions is a potential risk factor for ICU-AW.
摘要：
重症监护病房（ICU）-获得性虚弱（ICU-AW）是在危重患者中临床检测到的全身性肌肉无力，除危重疾病外没有其他可能的病因。ICU-AW在接受原位肝移植（OLT）的患者中并不常见。我们的报告揭示了在单个中心观察到的具有早期同种异体移植功能障碍的OLT患者中ICU-AW病例的最高数量。在2015年1月至2023年6月接受OLT的282例患者中，有7例（2.5％）在ICU中出现全身肌肉无力并接受了神经生理学检查。神经系统检查显示眼外保留，所有患者均无深层肌腱反射的弛缓性四肢瘫痪。神经生理学研究,包括肌电图和神经传导研究，显示异常与纤维性颤动的潜力和小的多相运动单位在检查的肌肉快速募集，以及复合肌肉动作电位和感觉神经动作电位的振幅降低，没有脱髓鞘的特征。所有患者的移植前临床状况都很关键。ICU入住期间,早期同种异体移植功能障碍，急性肾损伤，长时间机械通气，脓毒症,高血糖症,所有患者均出现高输血。两名患者再次移植。5名患者在90天时存活;2名患者死亡。在不合作的OLT患者中，神经生理学检查对于ICU-AW的诊断至关重要.在此设置中，大量红细胞输血是ICU-AW的潜在危险因素.
