Intensive Care Medicine

, Volume 22, Issue 9, pp 849–855 | Cite as

Polyneuropathies in critically ill patients: A prospective evaluation

  • K. Berek
  • J. Margreiter
  • J. Willeit
  • A. Berek
  • E. Schmutzhard
  • N. J. Mutz



To determine the incidence, severity and course of polyneuropathies in patients with sepsis or systemic inflammatory response syndrome combined with multiple organ failure.


Prospective study.


Division of Intensive Care Medicine of the Department of Anesthesiology and Intessive Care and Intensive Care Unit of the Department of Neurology, University Hospital Innsbruck, Austria.


Twenty-two patients between 23 and 77 years old with sepsis or systemic inflammatory response syndrome combined with multiple organ failure fulfilling strict inclusion and exclusion criteria.


Clinical neurologic examination and electromyography/nerve conduction velocity measurements during the stay on the Intensive Care Unit and 2–3 months later.

Measurements and results

In 9 of the 22 patients signs of polyneuropathy were found at the initial clinical investigation and in 7 patients at the follow-up investigation. Electrophysiologic investigation revealed signs of polyneuropathy in 18 patients initially and in 11 patients 2–3 months later.


In our patient population the frequency of the development of polyneuropathy was high (81.8%). Electrophysiologic investigation is superior to clinical neurologic examination in the detection of polyneuropathies.

Key words

Sepsis Systemic inflammatory response syndrome Multiple organ failure Electromyography Nerve conduction velocity Polyneuropathy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Brown WF (1987) The place of electromyoraphy in the analysis of traumatic peripheral nerve lesions. In: Brown WF, Bolton CF (eds) Clinical electromyography. Butterworth, Boston, pp 159–175Google Scholar
  2. 2.
    Anarson BGW (1984) Acute inflammatory demyelinating polyradiculoneuropathies. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) Peripheral neuropathy. Saunders, Philadelphia, pp 2050–2100Google Scholar
  3. 3.
    Bolton CF, Young GB, Zochodne DW (1993) The neurologic complications of sepsis. The neurologic complications of sepsis. Ann Neurol 33:94–100CrossRefPubMedGoogle Scholar
  4. 4.
    Messa JBL, Garcia A (1990) Acute polyneuropathy in critically ill patients. Intensive Care Med 16:159–162CrossRefPubMedGoogle Scholar
  5. 5.
    Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ (1984) Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry 47:1223–1231PubMedGoogle Scholar
  6. 6.
    Mertens HG (1961) Die disseminierte Neuropathie nach Koma. Nervenarzt 32:71–79PubMedGoogle Scholar
  7. 7.
    Gross MLP, Fowler CJ, Ho R, Russell RCG, Harrison MJG (1988) Peripheral neuropathy complicating pancreatitis and major pancreatic surgery. J Neurol Neurosurg Psychiatry 51:1341–1344PubMedGoogle Scholar
  8. 8.
    Op de Coul AAW, Lambregts PCLA, Koeman J, Van Puygenbroek MJE, Ter Laak HJ, Gabreels-Festen AAWM (1985) Neuromuscular complications in patients given Pavulon (pancuronium bromide) during artificial ventilation. Clin Neurol Neurosurg 87:17–22CrossRefPubMedGoogle Scholar
  9. 9.
    Waldhausen E, Keser G, Schulz B, Lippers P (1989) Weaning failure due to acute neuromuscular disease. Crit Care Med 17:594–595Google Scholar
  10. 10.
    Berek K, Schmutzhard E, Neumann M, Haring HP, Pfausler B, Berek A, Kofler M (1990) Acute polyneuropathy in critically ill patients. Intensive Care Med 16:473CrossRefGoogle Scholar
  11. 11.
    Berek K, Haring HP, Neumann M, Pfausler B, Berek A, Willeit J, Schmidauer C, Schmutzhard E (1991) Critically ill polyneuropathy — Komplikation beim beatmeten Patienten. Intensiv- und Notfallbehandlung 16: 32–36Google Scholar
  12. 12.
    Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RMH, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsss. Chest 101:1644–1655PubMedGoogle Scholar
  13. 13.
    Borzotta AP, Polk HC (1983) Multiple system organ failure. Surg Clin North Am 63:315–336PubMedGoogle Scholar
  14. 14.
    Goris RJA, Boekhorst A, Nuytinck JKS, Gimbrere JSF (1985) Multiple organ failure. Arch Surg 120:1109–1115Google Scholar
  15. 15.
    Witt NJ, Zochodne DW, Bolton CF, Grand'Maison F, Wells G, Young GB, Sibbald WJ (1991) Peripheral nerve function in sepsis and multiple organ failure. Chest 99:176–184PubMedGoogle Scholar
  16. 16.
    Montgomery AB, Stager MA, Carrico CJ, Hudson LD (1985) Causes of mortality in patients with the adult respiratory distress syndrome. Am Rev Respir Dis 132:485–489PubMedGoogle Scholar
  17. 17.
    Ludin HP, Tackmann W (1984) Polyneuropathien. Thieme, Stuttgart New YorkGoogle Scholar
  18. 18.
    Wertman E, Argov Z, Abramasky O (1988) Chronic inflammatory demyelinating polyradiciloneuropathy: features and prognostic factors with corticosteroid therapy. Eur Neurol 28:199–204PubMedGoogle Scholar
  19. 19.
    Zochodne DW, Bolton CF, Wells GA, Gilbert JJ, Hahn AF, Brown JD, Sibbald WA (1987) Critical illness polyneuropathy — a complication of sepsis and multiple organ failure. Brain 110:819–842PubMedGoogle Scholar
  20. 20.
    Liveson JA, Ma DM (1992) Laboratory reference for clinical neurophysiology. Davis, PhiladelphiaGoogle Scholar
  21. 21.
    Buchthal F, Rosenfalck P (1955) Action potential parameters in different human muscles. Acta Psychiatr Neurol Scand 30:125–132PubMedGoogle Scholar
  22. 22.
    Stöhr M, Bluthardt M (1993) Atlas der klinischen Elektromyographie und Neurographie. 3. Aufl. Kohlhammer, Stuttgart Berlin KölnGoogle Scholar
  23. 23.
    Kimura J (1984) Nerve conduction studies and electromyography. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) Peripheral neuropathy. Saunders, Philadelphia, pp 919–966Google Scholar
  24. 24.
    Le Gall JR, Loirat P, Alperovitch A (1989) The simplified acute physiology score (SAPS). Probl Crit Care 3: 578–584Google Scholar
  25. 25.
    Bolton CF, Laverty DA, Brown JD, Witt NJ, Hahn AF, Sibbald WJ (1986) Critically ill polyneuropathy: electrophysiological studies and differentiation from Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry 49: 563–573PubMedGoogle Scholar
  26. 26.
    Lycklama J, Nijeholt A, Troost J (1987) Critical illness polyneuropathy. In: Matthews WB (ed) Handbook of clinical neurology. Elsevier, Amsterdam, pp 575–580Google Scholar
  27. 27.
    Bright R (1827) Reports of medical cases selected with a view of illustrating the symptoms and cure of disease by a reference to morbid anatomy. Longman, London, pp 1–88Google Scholar
  28. 28.
    Osler W (1892) The principles and practice of medicine. Appleton, New York, pp 114–118Google Scholar
  29. 29.
    Dyck P (1989) Hypoxic neuropathy: does hypoxia play a role in diabetic neuropathy? The 1988 Wartenberg lecture. Neurology 39:111–118PubMedGoogle Scholar
  30. 30.
    Graham F, Neundörfer B, Erbguth F (1990) Disseminierte Polyneuropathie nach Koma. Dtsch Med Wschr 114: 1658–1661Google Scholar
  31. 31.
    Ebeling BJ, Rommelsheim K, Stoeckel H (1990) Elektrophysiologische Untersuchungen bei der Polyneuropathie von Intensivpatienten. Anäsh Intensivther Notfallmed 25:424–427Google Scholar
  32. 32.
    Waldhausen E, Keser G (1991) Lähmungen durch Kohlenhydrate unter der Intensivtherapie. Anaesthesist 40: 332–338PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • K. Berek
    • 1
  • J. Margreiter
    • 2
  • J. Willeit
    • 1
  • A. Berek
    • 2
  • E. Schmutzhard
    • 1
  • N. J. Mutz
    • 2
  1. 1.Universitätsklinik für NeurologieInnsbruckAustria
  2. 2.Division of Surgical and General Intensive Care MedicineUniversity HospitalInnsbruckAustria

Personalised recommendations