Critical illness polyneuropathy: What to look for in at-risk patients

Patients with respiratory failure related to systemic inflammatory response syndrome or sepsis and multiple-organ dysfunction are at significant risk for critical illness polyneuropathy (CIP), an axonal dysfunction of the peripheral motor nerves. Failure to wean the patient from mechanical ventilation is often the first sign of CIP; limb weakness, reduced deep tendon reflexes, predominantly distal symmetric paresis, and ataxia also may be noted. Electromyography and nerve conduction studies are used to distinguish CIP from Guillain-Barre syndrome, the principal disorder (in addition to neuromuscular blockade-related motor weakness) in the differential, and to establish the diagnosis. Specific treatment for CIP is lacking, but nutritional support, physical therapy, and avoidance of complications help promote recovery.