Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit Introduction Critical illness polyneuromyopathy (CIPM) has been recognized in association with systemic inflammatory response syndrome (SIRS), sepsis and multiple organ dysfunction syndrome (MODS). It is characterized by impairment of peripheral nerves and ⁄ or skeletal muscle and is differentiated from weakness associated with cen- tral nervous system dysfunction and from other types of peripheral neuromuscular abnormalities present at the time of intensive care unit (ICU) admission, like Guillain-Barre´ syndrome (1–4). CIPM constitutes an independent predictor of difficulty in weaning patients from the ventilator and results in prolonged ICU stay, increased hospitalization and increased morbidity and mor- tality (4–11). The descriptive term Ôcritical illness polyneur- omyopathyÕ is widely used because it encompasses both neuropathic and myopathic disease compo- nents. Even histological examination of tissue from Acta Neurol Scand 2008: 118: 175–181 DOI: 10.1111/j.1600-0404.2008.00996.x Copyright Ó 2008 The Authors Journal compilation Ó 2008 Blackwell Munksgaard ACTA NEUROLOGICA SCANDINAVICA Nanas S, Kritikos K, Angelopoulos E, Siafaka A, Tsikriki S, Poriazi M, Kanaloupiti D, Kontogeorgi M, Pratikaki M, Zervakis D, Routsi C, Roussos C. Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit. Acta Neurol Scand 2008: 118: 175–181. Ó 2008 The Authors Journal compilation Ó 2008 Blackwell Munksgaard. Objective – To investigate risk factors of critical illness polyneuromyopathy (CIPM) in a general multidisciplinary intensive care unit (ICU). Patients and methods – Prospective observational study in a 28-bed university multidisciplinary ICU. Four hundred and seventy-four (323 M ⁄ 151 F, age 55 Æ 19) consecutive patients were prospectively evaluated. All patients were assigned admission Acute Physiology and Chronic Health Evaluation (APACHE II; 15 Æ 7) and Sequential Organ Failure Assessment (SOFA; 6 Æ 3) scores and were subsequently evaluated for newly developed neuromuscular weakness. Other potential causes of new-onset weakness after ICU admission were excluded before CIPM was diagnosed. Results – Forty-four (23.8%) of 185 patients developed generalized weakness that met the criteria for CIPM. Patients with CIPM had higher APACHE II (18.9 Æ 6.6 vs 15.6 Æ 6.4, P = 0.004) and SOFA scores (8.4 Æ 2.9 vs 7.1 Æ 2.9, P = 0.013). According to multivariate logistic regression analysis, the following risk factors were independently associated with the development of CIPM: severity of illness at the time of ICU admission, administration of aminoglycoside antibiotics and high blood glucose levels. Analysis according to severity of illness stratification revealed the emergence of Gram ()) bacteremia as the most important independent predisposing factor for CIPM development in less severely ill patients. Conclusions – CIPM has a high incidence in the ICU setting. Our study revealed the association of aminoglycosides, hyperglycemia and illness severity with CIPM development, as well as the association between Gram ()) bacteremia and development of CIPM in less severely ill patient population. S. Nanas, K. Kritikos, E. Angelopoulos, A. Siafaka, S. Tsikriki, M. Poriazi, D. Kanaloupiti, M. Kontogeorgi, M. Pratikaki, D. Zervakis, C. Routsi, C. Roussos National and Kapodistrian University, Medical School, First Critical Care Department, Evangelismos Hospital, Athens, Greece Key words: critical illness polyneuromyopathy; Gram ()) bacteremia; hyperglycemia; hypoalbuminemia; incidence Serafim Nanas, First Critical Care Department, Medical School, National and Kapodistrian University, Evange- lismos Hospital, Ypsilantou 45-47, 10675 Athens, Greece Tel.: 0030-210-7201918 Fax: 0030-210-7244941 e-mail: snanas@cc.uoa.gr Accepted for publication January 7, 2008 175