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April 2, 2003

Paresis Following Mechanical Ventilation—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(13):1633-1635. doi:10.1001/jama.289.13.1633-a

To the Editor: In their observational study, Dr De Jonghe and colleagues1 found histological evidence of intensive care unit–acquired paresis (ICUAP) among 25% of patients who underwent mechanical ventilation for 7 or more days. The authors present their histological evidence of primary myopathy as novel and suggest that the clinical term "critical illness polyneuropathy" (CIP) may be too restrictive. We published similar results 6 years ago.2 We found evidence of primary myopathy in 19 of 24 patients with (5 cases) or without (15 cases) neurogenic signs; 4 other patients had a neurogenic myopathy. In total, 23 patients had a myopathy and 15 of them "would have been diagnosed as having only a critical illness polyneuropathy" had we not performed muscle biopsies. Drugs, including corticosteroids, were not related to these findings. Although others had used the term "critical illness polyneuromyopathy,"3 to my knowledge, ours was the first prospective cohort study to find that primary myopathy may be at least as frequent as CIP if the diagnosis is made with muscle biopsies. Other studies have replicated these results.4

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