query format

kmaxell@houstonmethodist.org

I cover ICU and have pts on ventilators for a number of days. bedridden/ muscle wasting. I would like to query for critical illness myopathy for SOI/ROM.  Any suggests on a non leading query??

Thank you

morris-jeff@CooperHealth.edu

You can query for this dx the same as any other...present the clinical indicators and clinically valid choices including other and unable to determine to the Provider and that should not be considered as leading.

Thanks,

Jeff

kmaxell@houstonmethodist.org

Jeff, thank you.

rwillcutt

We do not query for it unless we have a biopsy. 

lostwater

Do you provide education or guidelines or criteria on your query, or, as an adjunct to your query?  I see Critical Illness Myopathy similarly to Functional Quadriplegia in that it generally does not occur to the provider to "label" this with a diagnosis unless they have been educated as to the importance of capturing all diagnostic impacts to severity and risk.

Mark

hooter1964

For education:
From 2014 The ICU Book 4th edition

Critical Illness Neuromyopathy

The disorders known as critical illness polyneuropathy (CIP) and critical illness myopathy

(CIM) are secondary disorders, and typically accompany severe sepsis and other

conditions associated with progressive systemic inflammation .

Pathogenesis

CIP is a diffuse sensory and motor axonal neuropathy that is discovered in at least 50%

of patients with severe sepsis and septic shock . The onset is variable, occurring from 2 days to a few weeks after the onset of the septic episode. CIP is considered the most common peripheral neuropathy in critically ill patients CIM is a diffuse inflammatory myopathy that involves both limb and truncal muscles.

Predisposing conditions include severe sepsis and septic shock, and prolonged periods of

drug-induced neuromuscular paralysis, particularly when combined with high-dose

corticosteroid therapy. CIM has also been reported in one-third of patients with status asthmaticus who are treated with high-dose corticosteroids .

Clinical Features

As just mentioned, CIP and CIM often go undetected until there is an unexplained failure to remove a patient from mechanical ventilation. Physical examination will then reveal a flaccid quadriparesis with hypo-reflexia or areflexia. The diagnosis of CIP can be confirmed by nerve conduction studies (which show slowed conduction in sensory and motor fibers), and the diagnosis of CIM can be confirmed by electromyography (which shows myopathic changes) and by muscle biopsy (which shows atrophy, loss of myosin filaments, and inflammatory infiltration).

There is no treatment for CIP or CIM. Complete recovery is expected in about half the patients but it can takes months to recover.