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Fisiopatolog a de las Alteraciones Neuromusculares del Paciente Cr tico

Diferentes denominaciones. Critical Illness Polyneuropathy (CIP)Pure Motor Axonopathy. Acute Myopathy of Intensive CareAcute Necrotizing Myopathy of Intensive CareThick Filament MyopathyAcute Quadriplegic MyopathyAcute Steroid MyopathyCritical Illness MyopathyFloppy Person Syndrome. Anomali

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Fisiopatolog a de las Alteraciones Neuromusculares del Paciente Cr tico

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    1. Fisiopatologa de las Alteraciones Neuromusculares del Paciente Crtico

    2. Diferentes denominaciones Critical Illness Polyneuropathy (CIP) Pure Motor Axonopathy Acute Myopathy of Intensive Care Acute Necrotizing Myopathy of Intensive Care Thick Filament Myopathy Acute Quadriplegic Myopathy Acute Steroid Myopathy Critical Illness Myopathy Floppy Person Syndrome

    6. Definicin Afectacin del nervio perifrico et / ou de la unin neuro-muscular et / ou del msculo Acquirido en UCI-REA

    7. SNAPC polineuropatia miopata combinacin

    8. Unidad motora

    9. Unidad motora

    10. polifasia

    11. Incidencia No bien conocida. Se estima entre el 50 a 70 % de los pacientes crticos que presentan SIRS (tipo de paciente, momento evolutivo)

    12. Fisiopatologa del SNAPC Sndrome de respuesta inflamatoria sistmica (SIRS) situacin-proinflamatoria: taquicardia taquipnea hipotensin hipoperfusin oliguria leucocitosis / leucopenia episodios de hipotermia

    13. Factores de riesgo

    15. SIRS y sepsis SFMO VM duracin de la inmovilizacin curares y relajantes corticosteroides hiperglucemia hiperosmolaridad hipoalbuminemia NP GCS < 10 factores hormonales edad y gnero

    16. SNAPC factores de riesgo de Letter et al., Crit Care Med 2001 estudio prospectivo n=98, UCI resultados: 33% SNAPC factores de riesgo: SIRS y APACHE III score (Acute Physiology And Chronic Health Evaluation)

    17. Incidencia del SNAPC en pacientes de UCI agrupados por criterios de iso-gravedad High risk = APACHE III score + SIRS Medium risk = APACHE III score, sin SIRS Low risk = APACHE III score, sin SIRS

    18.

    20. Curares

    21. Vecuronium

    22. Suxemetonio

    23. Corticosteroides

    24. Duracin de la VM

    25. Asmticos en VM

    26. Severe Acute Asthma and CINMA Role of Neuromuscular Blockers

    27. Hiperglucemia

    28. SNAPC (y ultra-SIRS) microorganismos patgenos causa del SIRS papel de las interleucinas (1, 5, 6, 8, 11 y 15), del factor estimulante de colonias y de otras chemocinas inmunoactividad local

    29. Diagnstico Diferencial del SNAPC sndrome de Guillain-Barr + variedades porfiria aguda intermitente miopata necrtica aguda miositis aguda miopatas agudas con dficit de miosina

    30. Diagnstico del SNAPC

    31. Sumatorio de Factores de Riesgo

    32. Datos clnicos: Confusos

    33. Exploracin fsica: poco til

    34. Pruebas complementarias segn contexto clnico

    36. Morbilidad y Mortalidad Morbilidad: retraso del alta, calidad de vida (meses-aos), alteracin funcional de por vida Mortalidad: no claramente establecida

    37. Conclusiones Patologa frecuente en una poblacin particular Solo se diagnostica en los casos mas graves Axonal Y muscular Diagnstico EMG vs clnico FDR: inmovilizacin, drogas, hiperglucemia Prolongacin de la ventilacin mecnica Prevencin / tratamiento ?

    38. literatura De Letter MA et al. Critical illness polyneuropathy and myopathy (CIPNM): evidence for local immune activation by cytokine-expression in the muscle tissue. J Neuroimmunol 2000;106:206-13 De Letter MA et al. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med 2001;29:2388-90 Hund E. Neurological complications of sepsis: critical illness polyneuropathy and myopathy. J Neurol 2001;248:929-34 Latronico N, Shehu I, Seghelini E. Neuromuscular sequelae of critical illness. Curr Opin Crit Care 2005;11:381-90 Bolton CF. Neuromuscular manifestations of critical illness. Muscle Nerve 2005;32:140-63

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