Publication details
Neurologické poruchy v rámci kritického stavu
| Title in English | Neurological disorders in critical illness |
|---|---|
| Authors | |
| Year of publication | 2008 |
| Type | Article in Periodical |
| Magazine / Source | Česká a slovenská neurologie a neurochirurgie |
| MU Faculty or unit | |
| Citation | |
| Field | Neurology, neurosurgery, neurosciences |
| Keywords | Critical illness; sepsis; multiple organ failure; critical illness encephalopathy; critical illness polyneuropathy; critical illness myopathy |
| Description | Critical Illness is usually defined as a condition characterised by failure of one or more organs or systems as a result of a serious disease or trauma and usually accompanied by systemic inflammatory response syndrome. Among causes of critical illness are infections, usually respiratory ones, traumas, burns, great surgery or primary failure of one organ including central nervous system or neuromuscular failure. Original concept of sepsis as an inappropriate mobilization of defence mechanisms against virulent infection was modified by a concept of systemic inflammatory response syndrome as uncontrolled wide inflammatory response against not only infection and leading into multiple organ failure. Failure of cerebral functions in the form of diffuse encephalopathy, encephalopathy in critical illness, is usually an integral part of multiple organ failure. Among key signs are decreased level of consciousness and disordered cognitive functions (especially attention, cognition and orientation). Most scoring systems of multiple organ failure use the Glasgow coma scale to score the central nervous system failure. The aetiology of encephalopathy in critical illness is probably multifactorial and overlaps with that of etiologically unspecific syndrome of delirium. Encephalopathy in critical illness should be differentiated from infectious encephalitis and acute parainfectious autoimmune encephalopathies. Neuromuscular disorders in critically ill patients demonstrate especially as a new weakness (critical illness weakness). Beside exacerbation of preexisting neuromuscular disorder and persistent pharmacological blockade of neuromuscular transmission caused by nondepolarising muscle blocking agents, there exists the newly recognised cause called polyneuropathy and myopathy of critical illness. These disorders affect to some extend at least half of critically ill patients. Aetiology is probably multifactorial. Systemic inflammatory response syndrome and multiple organ failure are probably among important etiological factors. In critical illness myopathy, functional denervation caused by nondepolarising muscle blocking agents and high doses of corticosteroids have additional effect. Both conditions are frequently associated in the same patient: critical illness polyneuromyopathy. In contrast to original concept of complications of critical illness these conditions seem to be an integral part of multiple organ failure, a neuromuscular failure, analogical to the failure of other organs and systems. Critical illness polyneuropathy and myopathy are important risk factors of prolonged morbidity and mortality in critically ill patients. Current state of art in the area of aetiology and pathogenesis of critical illness doesnot enable the use of effective prevention and treatment of neuromuscular disorders. |
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