Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit

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 ± 19) consecutive patients were prospectively evaluated. All patients were assigned admission Acute Physiology and Chronic Health Evaluation (APACHE II; 15 ± 7) and Sequential Organ Failure Assessment (SOFA; 6 ± 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 ± 6.6 vs 15.6 ± 6.4, P = 0.004) and SOFA scores (8.4 ± 2.9 vs 7.1 ± 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.