Avaliação pelo teste de eletrodiagnóstico de estímulo das desordens eletrofisiológicas e neuromusculares em membros de pacientes criticamente enfermos

Abstract

Introduction: In critically ill patients, it is common to find neuromuscular impairment defined as intensive care unit-acquired weakness (ICUAW). This condition frequently affects peripheral and respiratory muscles, restricts activities of daily living and hinders functional recovery to previous levels. This condition frequently affects peripheral and respiratory muscles, restricts activities of daily living and hinders functional recovery to previous levels. Impairment of muscle strength, from weakness to paralysis, bilaterally involves the upper and lower limbs, mainly affecting the lower extremities, in patients admitted to the ICU. The stimulus electrodiagnostic test (SET) is non-invasive, safe, low-cost and viable to be used in this population and allows the identification of neuromuscular electrophysiological disorders (NED) that arise in the early stage of FAUTI. Objective: Evaluate neuromuscular electrophysiological disorders (NED) in the upper and lower limbs of critically ill patients using the SET during the first week of invasive mechanical ventilation (IMV). Methods: A prospective observational study was conducted on patients admitted to the ICU and on IMV. In the SET, the chronaxie, rheobase, and accommodation of the biceps brachii (BB) and tibialis anterior (TA) muscles were measured, bilaterally, on the 1st and 7th day of IMV. Results: Were evaluated twelve participants whom majority were male (83%) with an average age of 49.7 years. No differences were observed in the SET measurements related to laterality for both muscles on D1 and D7, nor when comparing D1 and D7 of the BB. For the TA, only the rheobase increased significantly on D7 (17.91 mA, p=0.03). On D1, the SET values for the BB were significantly lower compared to the TA, except for chronaxie, where the median was higher (350 μs, p=0.003). On D7, the chronaxie for the TA was higher (median 400 μs, p=0.001) and the accommodation index was lower (1.51) compared to the BB. Conclusion: Although no presence of NED was observed during the first week, the TA showed higher chronaxie values compared to the BB in both the first and second evaluations. There was no difference in lateralization regarding the SET measurements in BB and TA on the first and seventh days of IMV, suggesting that this test can be performed unilaterally without compromising the results, thereby optimizing the time for conducting the assessment.