Considerations for treatment, diagnosis and risk factors for critical care polyneuropathy

Background: Critical care polyneuropathy is a neuromuscular weakness that may be experienced in severe burn patients managed in intensive care with prolonged ventilation (Chan, Ng & Vandervord, 2010). Reducing long-term functional impairment requires early diagnosis. However, early diagnosis remains difficult with varying levels of sedation.

Aim: To identify the precipitating factors that contribute to the development of critical care polyneuropathy in severe burn injury.

Methods: An integrative review was undertaken, using a systematic approach. Research papers and case reports from the international literature were included in the review.

Results: The research studies identified an incidence of critical care polyneuropathy of 4.4% amongst a surveyed population comprising 2755 burns patients with a mean total burn surface area of 40%. While the risk factors have been poorly reported across the studies, the survey identified prolonged ventilation, failure to wean from a ventilator, larger and deeper burns and the occurrence of sepsis as causative factors.

Conclusion: Early identification of critical care polyneuropathy and subsequent intensive therapy is an important aspect in patients’ recovery that may strengthen activity and exercise tolerance. The long-term impact of critical care neuropathy therefore warrants further longitudinal investigation, and this review highlights the need for more systematic measurement and reporting of risk factors and assessment.