(Scientific Session) Critical Illness Myopathy and Polyneuropathy and COVID-19: A Literature Review

Background and/or Objectives: Critical illness myopathy (CIM) and polyneuropathy (CIP) are the most common forms of ICU acquired neuromuscular damage characterized by symmetric weakness most commonly of proximal muscles, flaccid muscle tone, and altered sensation. The details of the relationship between CIM and/or CIP and COVID-19 is still largely unknown. This study aims to review and synthesize all readily available literature that is related to CIM/P and COVID-19 to further clarify this relationship.

Design: A PubMed search was conducted with “critical illness myopathy” OR “critical illness polyneuropathy” AND “COVID-19” as keywords. Inclusion criteria included articles that highlighted the relationship between CIM/P and COVID-19 by analyzing clinical course, outcomes, incidence, or etiology and excluded reviews of articles.

Setting: n/a

Participants: n=685(total)

Interventions: n/a

Main Outcome Measures: Critical illness with multi-organ failure, muscle weakness with inability to wean off a ventilator, electrodiagnostic evidence of motor unit and recruitment abnormalities as well as an absence of excitability with muscle stimulation, a muscle biopsy suggestive of a primary myopathy

Results: A total of 55 articles were screened, of which 20 fulfilled inclusion criteria: 8 case reports, 4 prospective studies, 4 retrospective studies, 3 literature reviews, and 1 case series.

Conclusions: Various studies have highlighted neurological complications of COVID-19 but few have addressed COVID-19's relationship with CIM/P. The studies in this literature review helped illuminate incidence, prevalence, hypotheses for pathophysiology, risk factors, biomarkers, outcomes, treatment, recovery, prognosis, and healthcare costs. However, the body of research on this relationship is sparce, limiting generalizability of results. These 20 studies suggest COVID-19 is correlated to CIM/P as direct tissue, nerve, and/or organ damage is caused by the virus either through cytokine or chemokine pathways. Furthermore, this relationship can have implications on functional recovery and rehabilitation strategies. All studies conclude that further research is warranted to establish a standard of care for recovery and rehabilitation involving multisystem strengthening.