Neuropathies in Sepsis: a Difficult Situation to Wean from Ventilator

Abstract

Neuromuscular weakness in critically ill patients is diagnostic challenge. Septic Polyneuropathy is an important cause of failure to wean from artificial ventilation. We studied patient of septic polyneuropathy to highlight the importance of regular neurological examination in the early diagnosis of this conditions. Availability of facilities for bed side electrophysiological study & histopathology of muscle are important to diagnose these entity. A 56 years old lady was admitted in gastro-enterology unit with complains of abdominal pain & fever, subsequently she was diagnosed as a case of burst appendix with septicemia in Surgery Unit. Appendicectomy and surgical toileting was done under general anaesthesia. In the early post-operative period the patient developed respiratory failure and was transferred to ICU. She was on ventilator for a long time with all other investigation electrophysiological study of nerve conduction showed septic polyneuropathy. On 21st POD the patient could be withdrawn from ventilator and after T-piece trial extubation was done on the next day. Neuropathies in sepsis, an important cause of failure to wean from ventilator, a high index of suspicion and regular bed side neurological & electrophysiological examination is required to make an early diagnosis.  

Journal of BSA, Vol. 21, No. 1, January 2008 53-55