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Highly Accessed Review

Clinical review: Critical illness polyneuropathy and myopathy

Greet Hermans1, Bernard De Jonghe2, Frans Bruyninckx3 and Greet Van den Berghe4*

Author Affiliations

1 Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals, Katholieke Universiteit Leuven, Herestraat 49, B-3000 Leuven, Belgium

2 Réanimation Médico-chirurgicale, Centre Hospitalier de Poissy-Saint-Germain en Laye, Poissy, France, Rue du Champ Gaillard 10, F-78300 Poissy, France

3 Department of Physical Medicine and Rehabilitation, University Hospitals, Katholieke Universiteit Leuven, Herestraat 49, B-3000 Leuven, Belgium

4 Department of Intensive Care Medicine, University Hospitals, Katholieke Universiteit Leuven, Herestraat 49, B-3000 Leuven, Belgium

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Critical Care 2008, 12:238  doi:10.1186/cc7100

Published: 25 November 2008

Abstract

Critical illness polyneuropathy (CIP) and myopathy (CIM) are major complications of severe critical illness and its management. CIP/CIM prolongs weaning from mechanical ventilation and physical rehabilitation since both limb and respiratory muscles can be affected. Among many risk factors implicated, sepsis, systemic inflammatory response syndrome, and multiple organ failure appear to play a crucial role in CIP/CIM. This review focuses on epidemiology, diagnostic challenges, the current understanding of pathophysiology, risk factors, important clinical consequences, and potential interventions to reduce the incidence of CIP/CIM. CIP/CIM is associated with increased hospital and intensive care unit (ICU) stays and increased mortality rates. Recently, it was shown in a single centre that intensive insulin therapy significantly reduced the electrophysiological incidence of CIP/CIM and the need for prolonged mechanical ventilation in patients in a medical or surgical ICU for at least 1 week. The electrophysiological diagnosis was limited by the fact that muscle membrane inexcitability was not detected. These results have yet to be confirmed in a larger patient population. One of the main risks of this therapy is hypoglycemia. Also, conflicting evidence concerning the neuromuscular effects of corticosteroids exists. A systematic review of the available literature on the optimal approach for preventing CIP/CIM seems warranted.