Conséquences respiratoires de la neuromyopathie de réanimation

Critical illness neuromyopathy (CINM) occurs mainly in patients with prolonged multiorgan failure. CINM prolongs the duration of weaning from the ventilator and is associated with a higher risk of delayed reintubation. The diagnosis is mainly clinical, based on the recognition of a diffuse muscle weakness preferentially involving proximal parts of the limbs. Muscle weakness can be quantified using the MRC score. In patients with persisting altered consciousness at weaning onset as well as in those with an atypical context, an electrophysiological examination is necessary. Levels of locomotor and respiratory muscle involvement are correlated, and measurement of respiratory muscle strength parameters does not improve the prediction of MV prolongation obtained with measurement of the MRC score. Factors involved in the development of limb and respiratory muscle weakness might be similar. Among those, diaphragmatic inactivity under strictly controlled mechanical ventilation plays an important role as demonstrated in experimental studies. In CINM, patients with a severe limb involvement at weaning onset, a weaning strategy similar to the one used in neuromuscular patients is likely reasonable.