Critical illness polyneuromyopathy: Functional impact after severe acquired brain injuries.
OBJECTIVES
Critical illness polyneuropathy and myopathy (CIPNM) frequently affects critical patients and can occur after severe acquired brain injuries (sABI) influencing the functional recovery. We aimed to assess how the concomitance between CIPNM and sABI might influence the rehabilitative outcomes in terms of functional autonomy, oral feeding recovery and endotracheal tube weaning.


MATERIALS AND METHODS
Adult patients with sABI admitted to an intensive rehabilitation unit and underwent an electromyography examination within seven days after admission were included. Assessed rehabilitative outcomes at discharge were decannulation success and its timing, functional autonomy measured by the Functional Independence Measure (FIM) and the Glasgow outcome scale expanded (GOS-E) and oral feeding recovery assessed by the Functional Oral Intake Scale (FOIS) score.


RESULTS
Among the 224 included patients (81 (36%) females, age (median[IQR]): 68.73[21.66] years), 119 (53.1%) presented CIPNM at admission. Albeit the change of rehabilitative outcomes between admission and discharge was significant in all the sABI patients (P < .001 for ΔFOIS, ΔFIM and ΔGOS-E), those with a concomitant CIPNM achieved significantly lower scores as evaluated by Mann-Whitney tests (P < .001 for ΔFIM Δ and GOS-E; P < .005 for ΔFOIS). The CIPNM absence was associated with a higher probability to achieve functional autonomy (GOS-E > 4) (OR:4.57 (1.49/14.06); P < .01) and oral feeding recovery (FOIS ≥ 4) (OR:2.07 (1.07/3.99); P = .03) at discharge. CIPNM presence did not influence decannulation success but a longer time to cannula weaning was required (P < .01 in the log-rank test).


CONCLUSIONS
CIPMN significantly affects the rehabilitative outcomes after a sABI and should be taken into account for better rehabilitative handling.
['Hakiki|Bahia|B|https://orcid.org/0000-0001-8540-7405', 'Draghi|Francesca|F|', 'Scarpino|Maenia|M|https://orcid.org/0000-0002-9930-501X', 'Portaccio|Emilio|E|https://orcid.org/0000-0002-9662-1762', 'Romoli|Annamaria|A|https://orcid.org/0000-0003-3383-1241', 'Mannini|Andrea|A|https://orcid.org/0000-0003-0760-052X', 'Atzori|Tiziana|T|https://orcid.org/0000-0003-4487-0908', 'Lolli|Francesco|F|https://orcid.org/0000-0001-7181-6806', 'Macchi|Claudio|C|https://orcid.org/0000-0003-2265-3216', 'Grippo|Antonello|A|https://orcid.org/0000-0002-9997-8564']
D000328:Adult D000368:Aged D001930:Brain Injuries D005260:Female D023261:Glasgow Outcome Scale D006801:Humans D008297:Male D008875:Middle Aged D010351:Patient Discharge D011115:Polyneuropathies D020127:Recovery of Function
severe acquired brain injury critical illness polyneuropathy and myopathy rehabilitation oral feeding decannulation functional outcome