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February 14, 1996

Polyneuropathy After Mechanical Ventilation-Reply

Author Affiliations

Westeinde Hospital The Hague, the Netherlands

JAMA. 1996;275(6):443. doi:10.1001/jama.1996.03530300026022

In Reply.  —We thank Dr Teener and colleagues for their remarks. The list of nervous system afflictions in critical illness is still growing. Although critical illness polyneuropathy seems to be the most common peripheral nervous system disorder, one should always be aware of other possibilities. In particular, conventional EMG in the intensive care unit setting may underestimate myopathy.Nevertheless, we do not think our series of patients had acute quadriplegic myopathy, which has been reported in patients receiving a combination of curaromimetics and high-dose corticosteroids.1-3 Three patients received high-dose prednisolone, but only moderate amounts of vecuronium (for 2, 6, and 7 days). In two of them, prednisolone was given weeks after discontinuation of vecuronium and the development of tetraparesis. The one surviving patient had a clear clinical picture of polyneuropathy, including distal sensory disturbances. Early recruitment in needle EMG was not found.It remains uncertain whether, in a series