RISK FACTORS FOR DEVELOPMENT OF CRITICAL ILLNESS POLYNEUROPATHY AND MYOPATHY IN PEDIATRIC CRITICAL CARE UNIT.

Critical illness polyneuropathy and myopathy (CIPNM) is a major complication of severe critical illness and management. CIPNM prolongs weaning from mechanical ventilation and physical rehabilitation since both limb and respiratory muscles can be affected. Many risk factors have been ever proposed for the CIPNM including sepsis, multiple organ failure, neuromuscular blocking agents etc. However, the data are heterogeneous and no consensus is present in this regard. This study aimed to evaluate possible risk factors in development of CIPNM in pediatric intensive care unit (PICU).

Methods & Materials: In this observational study, 57 patients (aged 1 month to 14 years) in PICU and on mechanical ventilation (MV) for at least one week were recruited during a 24-month period in Tabriz Children Teaching Hospital. The CIPNM was diagnosed in 13 cases (22.8%) based on clinical and electrodiagnostic findings. Different variables including age, sex, PRISM score, duration of MV and PICU stay, accompanying pathologic conditions, medications and in-hospital outcome were compared between both groups with and without CIPNM.

Results: Sepsis and multiorgan dysfunction were significantly more frequent in the CIPNM group (6.8% vs. 38.5, p=0.01, OR=8.5 with 95%CI: 1.7-43.1 and 43.2% vs. 76.9, p=0.03, OR=4.4 with 95%CI: 1.1-18.2 respectively). Midazolam was administered more frequently in the non-CIPNM group (88.6% vs. 53.8, p=0.01, OR=0.2 with 95%CI: 0.0-0.6). There was no significant difference between the two groups regarding age, sex, PRISM score, duration of MV and PICU stay, other accompanying pathologic conditions (malnutrition, prolonged immobility) and other medications (pancuronium, steroids, aminoglycosides). The mortality rate was comparable between the two groups (4.5% in non-CIPNM group vs. 15.4% in the CIPNM group p=0.22). In multivariate analysis, the sepsis and midazolam administration were the mere significant contributors to the CIPNM.

Conclusion: Based on our findings, sepsis is a dependent risk factor for occurrence of CIPNM. On the other hand, midazolam seems to be an independent protector against this condition.