REVIEW – January 2009

Neuromuscular manifestations in the intensive care unit: critical illness polyneuropathy and myopathy


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The review paper describes the history and background of clinical entities which often present with treatment difficulties in. A personal observation is given as an illustration of the issue. It is stressed that neuromuscular manifestations are rather common in the ICU, especially in patients who are also septic, have multiorgan dysfunction and SIRS and who receive neuromuscular blocking agents and  corticosteroids. The need for EMG and nerve conduction studies together with muscle biopsy and CPK measurements is stressed. The differential diagnosis includes the Guillaine-Barré syndrome, porphyria and other causes of predominant motor neuropathy. The importance of the treating rationale of underlying conditions is pointed out. Discontinuation of ventilation is set by the time of resolution of neuropathy. Neuromuscular manifestations are associated with increased mortality, prolonged mechanical ventilation and prolonged rehabilitation.