Approach to critical illness polyneuropathy and myopathy

Postgraduate Medical Journal
S PatiD Hilton-Jones

Abstract

A newly acquired neuromuscular cause of weakness has been found in 25-85% of critically ill patients. Three distinct entities have been identified: (1) critical illness polyneuropathy (CIP); (2) acute myopathy of intensive care (itself with three subtypes); and (3) a syndrome with features of both 1 and 2 (called critical illness myopathy and/or neuropathy or CRIMYNE). CIP is primarily a distal axonopathy involving both sensory and motor nerves. Electroneurography and electromyography (ENG-EMG) is the gold standard for diagnosis. CIM is a proximal as well as distal muscle weakness affecting both types of muscle fibres. It is associated with high use of non-depolarising muscle blockers and corticosteroids. Avoidance of systemic inflammatory response syndrome (SIRS) is the most effective way to reduce the likelihood of developing CIP or CIM. Outcome is variable and depends largely on the underlying illness. Detailed history, careful physical examination, review of medication chart and analysis of initial investigations provides invaluable clues towards the diagnosis.

Citations

Sep 18, 2009·Pediatric Blood & Cancer·Jorma CharisiusChristof Maria Kramm
Aug 21, 2013·Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research·Oytun ErbaşGönül Peker
Jul 5, 2012·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Jennifer ConferRobert Hayes
Jan 26, 2021·Pain Reports·Christine H Meyer-FrießemElena K Enax-Krumova
Dec 8, 2020·Neurological Research and Practice·Peter BerlitThomas Hummel
Aug 5, 2011·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Renu B Pattanshetty, Gajanan S Gaude
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Dec 17, 2009·Current Opinion in Rheumatology

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