A.Druschky
M.Herkert
M.Radespiel-Tröger
K.Druschky
E.Hund
C.-M.Becker
M.J.Hilz
F.Erbguth
B.Neundörfer
Critical illness polyneuropathy:
clinical findings and cell culture
assay of neurotoxicity assessed
by a prospective study
Received:1September2000
Finalrevisionreceived:3January2001
Accepted:31January2001
Publishedonline:16March2001
Springer-Verlag2001
A.Druschky
)
)´K.Druschky´
M.J.Hilz´F.Erbguth´B.Neundörfer
DepartmentofNeurology,
UniversityofErlangen-Nuernberg,
Schwabachanlage6,
91054Erlangen,Germany
E-mail:achim.druschky@rzmail.uni-
erlangen.de
Phone:+49-9131-8533001
Fax:+49-9131-8536179
M.Herkert´C.-M.Becker
DepartmentofBiochemistry,
UniversityofErlangen-Nuernberg,
Fahrstr.17,
91054Erlangen,Germany
M.Radespiel-Tröger
DepartmentofMedicalInformatics,
BiometryandEpidemiology,
UniversityofErlangen-Nuernberg,
Waldstr.6,
91054Erlangen,Germany
E.Hund
DepartmentofNeurology,
UniversityofHeidelberg,
ImNeuenheimerFeld400,
69120Heidelberg,Germany
M.J.Hilz
DepartmentofNeurology,
NewYorkUniversityMedicalCenter,
550FirstAvenueNewYork,
N.Y.10016,USA
Abstract Objective:First,toevalu-
atetheroleoftypicalintensivecare-
relatedconditionslikesepsis,pro-
longedventilation,drugeffectsand
metabolicdisordersinthepatho-
genesisofcriticalillnesspolyneu-
ropathyCIP);second,toinvesti-
gatethepossiblesignificanceofpa-
tientserumneurotoxicityassessed
byaninvitrocytotoxicityassaywith
respecttoCIPdevelopment.
Design: Prospectivestudy.
Setting: Neurologicalintensivecare
unit.
Patientsandparticipants: Twenty-
eightpatientswhowereonmechan-
icalrespiratorysupportforatleast
4daysduringa21-monthstudype-
riod.
Results: DiagnosisofCIPwasestab-
lishedbyclinicalandelectrophysio-
logicalexaminationin1657%)of
28patients.Patientswereinvesti-
gatedondays4,8and14ofme-
chanicalventilation.Twoof16CIP
patientshadclinicalsignsofpoly-
neuropathyatinitialexamination.
Factorsthatcorrelatedsignificantly
withthedevelopmentofCIPwere:
themultipleorganfailurescoreon
day8ofventilation,thetotaldura-
tionofrespiratorysupport,the
presenceofweaningproblemsand
themanifestationofcomplicating
sepsisand/orlungfailure.Thein
vitrotoxicityassayshowedserum
neurotoxicityin12of16CIPpa-
tients.Electrophysiologicalinvesti-
gationsyieldedfalsepositiveresults
ofthetoxicityassayinsixpatients
notdevelopingCIP)andfalseneg-
ativeresultsinfourpatientsdevel-
opingclinicalandelectrophysiologi-
calsignsofCIP).Statisticalanalysis
didnotrevealasignificantcorrela-
tionbetweenthediagnosisofCIP
andthefindingserumneurotoxicity.
Conclusion: Theresultssupportthe
hypothesisofamulti-factorialaeti-
opathogenesisofCIP.Weobserved
serumneurotoxicityinthemajority
ofCIPpatients,indicatingthepos-
sibleinvolvementofasofarun-
known,low-molecular-weightneu-
rotoxicagentinCIPpathogenesis.
Key words Criticalillness
polyneuropathy´Prognostic
factors´Neurotoxicity´Cellculture
assay´Electromyography
IntensiveCareMed2001)27:686±693
DOI10.1007/s001340100890
ORIGINAL