Tuesday January 17, 2006
Recovery of Critical illness polyneuropathy (CIP) and prevention with tight insulin therapy
Critical illness polyneuropathy (CIP) remains a major problem in ICU particularly in post-disease phase. Very little literature is available regarding recovery from CIP. A rather small but worth looking study done in france with 2-year clinical follow-up of 19 patients who suffered from CIP. Three parameters were significantly correlated with poor recovery:
1. longer length of stay in the critical care unit,
2. longer duration of sepsis and
3. greater body weight loss.
On prevention side, its worth recalling Dr. Van den Berghe famous 2001 NEJM article re. Intensive Insulin Therapy in Critically Ill Patients which showed intensive insulin therapy also reduced critical-illness polyneuropathy by 44 percent, and 49% in another followup study by same author.
Here is a good review article on CIP with free registration at medscape.com: Clinical Outcomes of Critical Illness Polyneuropathy - Pharmacotherapy 22(3):373-379, 2002
References: Click to get articles/abstract
1. Critical Illness PolyneuropathyA 2-Year Follow-Up Study in 19 Severe Cases - European Neurology 2000;43:61-69
2. Intensive Insulin Therapy in Critically Ill Patients NEJM Nov. 2001, Volume 345:1359-1367
3. Paresis Acquired in the Intensive Care Unit JAMA. 2002;288:2859-2867 (full article available with free registration).
4. Insulin therapy protects the central and peripheral nervous system of intensive care patients - NEUROLOGY 2005;64:1348-1353