Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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
Latronico N. Paresis Following Mechanical Ventilation—Reply. JAMA. 2003;289(13):1633-1635. doi:10.1001/jama.289.13.1633-a