Four septic patients and one asthmatic patient are described who developed a severe paralytic disorder in an intensive care unit (ICU), associated with a rise in serum creatine kinase and a severe necrotizing myopathy. All cases had received non-depolarizing muscle blocking agents and large intravenous doses of glucocorticoids. Three patients developed myoglobinuria. No improvement or very little improvement in muscle function was noted in the four fatal cases. The single survivor recovered his strength after 6 months. This syndrome (ldquo;necrotizing myopathy of intensive carerdquo;) provides one of the differential diagnoses for ICU-acquired weakness. The myopathy appears to have several interdependent causes and it is proposed that these should be classified as myonecrosis ldquo;primingrdquo; factors (glucocorticoids, myotropic infections, sepsis) and ldquo;triggeringrdquo; factors (non-depolarizing muscle blocking agents).
展开▼
