Abstract Details

Title Multimodal Assessment of Intensive Care Unit-Acquired Weakness in Severe Stroke Patients

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) Neuromuscular and Clinical Neurophysiology (EMG) Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 140

Objective To evaluate the clinical, electrophysiological, and laboratory features and to examine muscle mitochondrial respiratory complex activities in severe acute stroke patients developing intensive care unit-acquired weakness (ICUAW).

Background ICUAW defines generalized muscle weakness seen in critically ill patients in the absence of causative factors other than critical illness. Sepsis, multiorgan failure, immobilization, hyperglycemia, age, corticosteroids, and neuromuscular blocking agents cause ICUAW through activation of inflammatory pathways, mitochondrial dysfunction, increased proteolysis, impaired autophagic mechanisms, or impaired protein synthesis. Diagnostic methods include clinical muscle strength assessment, electrophysiological studies, muscle and nerve biopsies.

Design/Methods We prospectively recruited 24 stroke patients hospitalized in the neurology ICU during the sixteen-month period. Basal nerve conduction studies (NCS) were performed on patients in the first week of hospitalization, and the patients were followed by serial NCSs. When clinical findings and NCS were compatible with ICUAW, muscle biopsy was performed and respiratory complex activities were studied and compared with controls.

Results The frequency of ICUAW confirmed by NCS was 33% (n=8) in severe acute stroke patients. The parameters best predicting the development of ICUAW were compound muscle action potential (CMAP) amplitude of vastus medialis muscle and CMAP duration of abductor digiti minimi (ADM) muscle, and the most informative electropysiological findings during the entire study period was obtained within the first 11 days. Muscle biopsies revealed varying degrees of type 2 muscle fiber atrophy. Complex I and IV activities decreased in patients with ICUAW compared to controls.

Conclusions Vastus medialis CMAP amplitude, which has not been studied before to our knowledge, was the best predicting parameter in the development of ICUAW. Changes in respiratory complex activities in patients were similar to septic ICUAW patients, although only 3 were septic in our cohort. Studying all these parameters in larger cohorts is essential to understand ICUAW pathogenesis better.

Authors/Disclosures
Berin Inan PRESENTER	Berin Inan has nothing to disclose.
Can Ebru Kurt, MD (Hacettepe University)	Can Ebru Kurt, MD has nothing to disclose.
Zeynep Ergül Ülger (Hacettepe Üniversitesi)	Zeynep Ergül Ülger has nothing to disclose.
	No disclosure on file
	No disclosure on file
Ethem Murat Arsava, MD	Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Nutricia. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbott. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Fresenius. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Daichi-Sankyo. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Nutricia. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbott. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer. Dr. Arsava has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Daichi Sankyo. Dr. Arsava has received research support from TUBITAK.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Ersin Tan, MD	Dr. Tan has nothing to disclose.
Cagri Mesut Temucin (Hacettepe University Medical School Neurology Dep)	Cagri Mesut Temucin has nothing to disclose.

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Abstract Details