title: Clinical review: Critical illness polyneuropathy and myopathy.
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.
authors.affiliation: Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals, Katholieke Universiteit Leuven, Herestraat 49, B-3000 Leuven, Belgium. Greet.hermans@uz.kuleuven.be
authors.forename: Greet
authors.initials: G
authors.lastname: Hermans
authors.forename: Bernard
authors.initials: B
authors.lastname: De Jonghe
authors.forename: Frans
authors.initials: F
authors.lastname: Bruyninckx
authors.forename: Greet
authors.initials: G
authors.lastname: Van den Berghe
mesh_terms: D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D009135:Muscular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy; D011115:Polyneuropathies / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy