Neuromuscular alterations in the critically ill patient: critical illness myopathy, critical illness neuropathy, or both?

Excerpt

"During a four year period, five patients developed a severe polyneuropathy within one month of admission to a critical care unit" [1]. When first systematically described in the early 1980s, critical illness polyneuropathy (CIP) seemed no more than a scientific curiosity. Research over the past 20 years from Europe and Canada, however, has shown that CIP is the most frequent acute polyneuropathy encountered in the critically ill patients [2]. Although the exact incidence in unknown due to wide variation in diagnostic criteria and patients case-mix, available data regarding the incidence of CIP in critically ill patients are rather impressive: 58% in patients with a prolonged (>1 week) intensive care unit (ICU) stay [3], 68.5% in patients with sepsis [4], 70% in patients with multiple organ failure [5], 76% in patients with septic shock [6], and 82% in patients with sepsis and multiple organ failure [7]. If a prudent estimate is accepted that two patients with CIP are discharged yearly from each ICU, and if data on long-term outcome showing persisting abnormalities 1–5 years after ICU discharge are considered [3, 8, 9], the impact of CIP on the patient's quality of life would become clear: CIP can be an important cause of persisting ataxia, muscle weakness, and paralysis in survivors of critical illness. Numbers are even better appreciated if one takes into consideration that large regional centers for acute neuromuscular diseases admit 15 patients with Guillain-Barré syndrome per year [10]. …