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

Miss Andrea Mc Kittrick1, Dr  Rachel Kornhaber2,3, Dr Denis Visentin2, Professor Michelle Cleary2, Professor Josef Haik3,4,5, Dr Moti Harats3,4

1Royal Brisbane & Women’s Hospital , Alderley , Australia, 2School of Health Sciences, University of Tasmania, Rozelle Campus, Sydney, Australia, 3Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel, 4Sackler School of Medicine, Tel Aviv Unversity, Tel Aviv, Israel, 5Talpiot Leadership program, Sheba Medical Center, Tel Hashomer, Israel

Abstract:
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.

Chan, Q., Ng, K., & Vandervord, J. 2010, ‘Critical illness polyneuropathy in patients with major burn injuries’, Eplasty, Vol. 10, pp. 568-574.

Biography:
Andrea Mc Kittrick is an Occupational Therapist at the Royal Brisbane & Women’s Hospital in Brisbane. She completed a Masters of Science in Hand Therapy in 2015. Andrea is the current Chair of the Allied Health Group of ANZBA and is part of an international research team collaborating with the University of Tasmania and The National Burns Center at Sheba Medical Centre in Israel.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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