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|Critical Illness Myopathie|
|Main title||Critical Illness Myopathie|
|Subtitle||Risikofaktoren während der frühen systemischen Inflammation|
|Title variations||Critical illness myopathie|
|Subtitle for translated title||risk factors during the early course of ciritical illness|
Place of birth: Germersheim
|1. Referee||Priv.-Doz. Dr. D. Keh|
|Further Referee(s)||Prof. Dr. med. habil. B. Frank
Prof. Dr. med. H. Gerlach
|Keywords||Critical Illness Myopathy, CIM, IL-6, SOFA-II, dmCMAP|
|Classification (DDC)||610 Medical sciences; Medicine|
|Summary||Critical illness myopathy (CIM) is a serious complication of organ failure caused by severe septic process. CIM is associated with prolonged weaning from mechanical respiration, increased comorbidity, prolonged hospital stay and reduced quality of life. The objective of this study was to investigate risk factors for the development of critical illness myopathy during early course of critical illness.
I performed a prospective observational study. While mapping potential risk factors for ICUAP a neurologist made an examination of the muscle membrane excitability after direct muscle stimulation (dmCMAP). Patients were enrolled in the study if there were a simplified acute physiology (SAPS-II) score ≥ 20 on 3 successive days within 1 week after ICU admission. Then the predisposing risk factors were investigated prior to the first occurrence of abnormal dmCMAP. Nonparametric analysis of two-factorial longitudinal data and multivariate analysis were used for statistical analysis.
22 patients of 40 developed a reduced muscle membrane excitability within 7 days (5 / 9, 25). These risk factors were found: inflammation, disease severity, catecholamine and sedation requirements and insulin resistance. Administration of low-dose hydrocortisone in septic shock, of aminoglycosides and of neuromuscular blocking agents could not confirm as risk factors. Interleukin-6 (IL-6), as marker for systemic inflammation, is a significant risk factor for the development for the development of impaired muscle membrane excitability (multivariate Cox regression analysis; Hazard Ratio 1.006, 95%-CI (1.002 to 1.011), p = 0.002).
The only independent risk factor for critical illness myopathy in the early course of critical illness is systemic inflammation. If there are patients with SOFA II ≥ 10 and IL-6 plasma levels ≥ 230 pg/ml at day 4 after ICU admission, the results allow to recommend an examination of the muscle membrane excitability after direct muscle stimulation because of the risk of development of CIM.
PDF-Datei von FUDISS_thesis_000000025412
|Number of pages||99|
|FU Department||Department of Medicine - Charité - University Medicine Berlin|
|Year of publication||2011|
|Document type||Doctoral thesis|
|Date of defense||2011-11-18|
|Created at||2011-10-10 : 12:19:40|
|Last changed||2011-11-08 : 10:21:09|