To the Editor.
—The article by Dr Leijten and colleagues1 merits comment. The authors studied 50 patients receiving mechanical ventilation for more than 7 days and reported a high incidence of what they define as critical illness polyneuropathy. However, it is likely that a subset of the patients they reported actually had acute quadriplegic myopathy, which is an increasingly recognized disorder that produces prolonged neuromuscular weakness in the intensive care unit and may be confused with critical illness polyneuropathy.Some of the reported patients received prolonged neuromuscular blockade (vecuronium up to 21 days) and a small number received prednisolone. Both drugs are linked with acute quadriplegic myopathy.2 In two of nine postmortem studies, the authors report that myopathy was present that had not been detected by electromyography (EMG). One of the features of acute quadriplegic myopathy that has made it difficult to distinguish from neuropathy is the low
Teener JW, Rich MM, Raps EC, Bird SJ. Polyneuropathy After Mechanical Ventilation. JAMA. 1996;275(6):442-443. doi:10.1001/jama.1996.03530300026021