Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit.
OBJECTIVE
To investigate risk factors of critical illness polyneuromyopathy (CIPM) in a general multidisciplinary intensive care unit (ICU).


METHODS
Prospective observational study in a 28-bed university multidisciplinary ICU. Four hundred and seventy-four (323 M/151 F, age 55 +/- 19) consecutive patients were prospectively evaluated. All patients were assigned admission Acute Physiology and Chronic Health Evaluation (APACHE II; 15 +/- 7) and Sequential Organ Failure Assessment (SOFA; 6 +/- 3) scores and were subsequently evaluated for newly developed neuromuscular weakness. Other potential causes of new-onset weakness after ICU admission were excluded before CIPM was diagnosed.


RESULTS
Forty-four (23.8%) of 185 patients developed generalized weakness that met the criteria for CIPM. Patients with CIPM had higher APACHE II (18.9 +/- 6.6 vs 15.6 +/- 6.4, P = 0.004) and SOFA scores (8.4 +/- 2.9 vs 7.1 +/- 2.9, P = 0.013). According to multivariate logistic regression analysis, the following risk factors were independently associated with the development of CIPM: severity of illness at the time of ICU admission, administration of aminoglycoside antibiotics and high blood glucose levels. Analysis according to severity of illness stratification revealed the emergence of Gram (-) bacteremia as the most important independent predisposing factor for CIPM development in less severely ill patients.


CONCLUSIONS
CIPM has a high incidence in the ICU setting. Our study revealed the association of aminoglycosides, hyperglycemia and illness severity with CIPM development, as well as the association between Gram (-) bacteremia and development of CIPM in less severely ill patient population.
Nanas
S
S
National and Kapodistrian University, Medical School, First Critical Care Department, Evangelismos Hospital, Athens, Greece. snanas@cc.uoa.gr
Kritikos
K
K
Angelopoulos
E
E
Siafaka
A
A
Tsikriki
S
S
Poriazi
M
M
Kanaloupiti
D
D
Kontogeorgi
M
M
Pratikaki
M
M
Zervakis
D
D
Routsi
C
C
Roussos
C
C
D018806:APACHE; D000617:Aminoglycosides / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016470:Bacteremia / Q000150:complications; D001786:Blood Glucose; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011115:Polyneuropathies / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D001786:Blood Glucose