Critical illness neuromyopathy

It was not until the seminal work of Bolton and colleagues in 1984, that the clinical, electrodiagnostic, and pathological features of neuromuscular weakness associated with critical illness were described, and the term critical illness polyneuropathy (CIP) was introduced. Given that neuropathy and myopathy may often occur together in the same patient, the term critical illness neuromyopathy (CINM) may be the most appropriate clinical designation of acquired neuromuscular weakness in the critically ill patient. The evidence-based discussion provided in this chapter focuses on the reduction of CINM incidence and severity, including the following three topics: Reduction of CINM incidence utilizing intensive insulin therapy; Treatment of CINM using early physical and occupational therapy and sedation interruption; and Reduction of CINM incidence using electrical muscle stimulation. The topics are preceded by a clinical scenario that provides the foundation for a clinical question, and for each topic a subsequent critical appraisal of the literature.