Critical Illness Polyneuropathy and Myopathy and Clinical Detection of the Recovery of Consciousness in Severe Acquired Brain Injury Patients with Disorders of Consciousness after Rehabilitation

Diagnostics

Francesca Cecchi¹  Raisa Sterpu¹  Antonello Grippo¹  Anna Maria Romoli¹  Silvia Pancani¹  Bahia Hakiki¹  Andrea Mannini¹  Francesca Draghi¹  Claudio Macchi¹  Maenia Scarpino¹ 

[1] IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143 Florence, Italy;

关键词: severe acquired brain injury;    disorders of consciousness;    critical illness polyneuropathy and myopathy;    Coma Recovery Scale-Revised;    neurophysiology;    rehabilitation;   

DOI  :  10.3390/diagnostics12020516

来源: DOAJ

【 摘 要 】

Background: Disorders of consciousness (DoCs) include unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS). Critical illness polyneuropathy and myopathy (CIPNM) is frequent in severe acquired brain injuries and impacts functional outcomes at discharge from the intensive rehabilitation unit (IRU). We investigated the prevalence of CIPNM in DoCs and its relationship with the consciousness assessment. Methods: Patients with DoCs were retrospectively selected from the database including patients admitted to the IRU of the IRCCS Don Gnocchi Foundation, Florence, from August 2012 to May 2020. Electroneurography/electromyography was performed at admission. Consciousness was assessed using the Coma Recovery Scale-Revised (CRS-R) at admission and discharge. Patients transitioning from a lower consciousness state to a higher one were classified as improved responsiveness (IR). Results: A total of 177 patients were included (UWS: 81 (45.8%); MCS: 96 (54.2%); 78 (44.1%) women; 67 years (IQR: 20). At admission, 108 (61.0%) patients had CIPNM. At discharge, 117 (66.1%) patients presented an IR. In the multivariate analysis, CRS-R at admission (p = 0.006; OR: 1.462) and CIPNM (p = 0.039; OR: −1.252) remained significantly associated with IR only for the UWS patients. Conclusions: CIPNM is frequent in DoCs and needs to be considered during the clinical consciousness assessment, especially in patients with UWS.

【 授权许可】

Unknown