ICU-acquired weakness in a child diagnosed with critical illness polyneuropathy based on CT examination of erector spinae muscles

Abstract

ICU-acquired weakness (ICU-AW) is a general term used for acute diffuse muscle weakness that develops in critically ill patients and includes conditions such as critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). In this case, lung transplantation was performed on a 6-year-old boy with severe respiratory failure. Due to a combination of many risk factors, the patient experienced ICU-AW with a Medical Research Council (MRC) score of 0. CT of the erector spinae muscles showed that the cross-sectional area of the patient’s muscles was maintained, suggesting that the main cause of muscle weakness was CIP. Rehabilitation did not proceed well because of the patient’s unstable respiratory condition, and the mass of the erector spinae muscles remained unchanged; nevertheless, muscle weakness showed a marked improvement. We speculated that this clinical course supports a diagnosis of CIP. While CIM recovery takes weeks to months, an improvement in CIP may take years; thus, a differentiation between the two is important when considering long-term prognosis. Critically ill children should undergo imaging tests, including CT, which help diagnose ICU-AW and accurately differentiate pathological conditions.