Critical Illness Polyneuropathy


Critical Illness Polyneuropathy, Neuropathy Following ICU Admission

  • Pathophysiology
  1. Neurogenic atrophy and axonal degeneration results in acute motor and sensory denervation
  2. Results in leg and respiratory Muscle Weakness
  • Risk Factors
  1. Prolonged ICU Admission
  2. Sepsis
  3. Multiorgan Failure
  4. Hyperglycemia
  • Diagnosis
  1. Similar diagnostic criteria for Myopathy Following ICU Admission
  2. Limb Weakness AND
  3. Unexplained difficult mechanical Ventilator Weaning
  • Management
  1. Physical rehabilitation
    1. No current evidence to support for confirmed Polyneuropathy (and no Myopathy)
    2. Contrast with Myopathy Following ICU Admission in which physical therapyis effective
  2. Neuropathic pain management
    1. Capsaicin Cream
    2. Anticonvulsants such as Gabapentin (Neurontin) or Pregabalin (Lyrica)
    3. Selective Serotonin Reuptake Inhibitors (SSRI)
    4. Serotonin Norepinephrine Reuptake Inhibitors such as Venlafaxine (Effexor) or Duloxetine (Cymbalta)
  • Course
  1. Nerve function improves as medical disorders improve, but weakness and numbness may persist
  2. Resolves in most cases within 3 years of ICU discharge
  • Prevention
  1. Early mobilization in ICU improves mobility and strength