ICU · Neurocritical care / neuromuscular

Critical-Illness Polyneuropathy & Myopathy (CIPNM) — ICU-Acquired Weakness

Also known as Critical illness polyneuropathy · CIP · Critical illness myopathy · CIM · CIPNM · ICU-acquired weakness · ICUAW · Failure to wean · Thick-filament myosin loss · MRC sum score · Van den Berghe · NICE-SUGAR · Early mobilisation

The critical-illness polyneuropathy and myopathy (CIPNM, the ICU-acquired weakness) is an acquired weakness of the critically ill patient, developing after the sepsis, the multi-organ failure, or the prolonged ventilation. It comprises two overlapping entities — the critical illness polyneuropathy (the CIP, an axonal sensorimotor neuropathy) and the critical illness myopathy (the CIM, a myosin-loss myopathy, classically from the corticosteroids plus the neuromuscular blockers in the asthma and the ARDS). The clinical hallmark is the failure to wean from the ventilation, with the flaccid weakness, the areflexia, and the muscle wasting — the cranial nerves are SPARED (a useful discriminator from the Guillain-Barre). The only proven prevention is the glucose control (the Van den Berghe trial) and the early mobilisation; minimise the sedation, the corticosteroids, and the neuromuscular blockers. The recovery is over weeks to months and is often incomplete (a long-term disability).