Intensive Care Unit-Acquired Paresis: Spectrum of Neuromyopathies

and NMBAs are added, there is oxidative stress. The blood vessels supplying peripheral nerves lack autoregulation and the cytokines are responsible for increased capillary permeability, there is endoneurial damage and hypoxia. The glutathione level, both total and reduced form, is reduced in the muscle. There is mitochondrial dysfunction and oxidative stress, glutamine depletion to 15%, impaired reutilization of oxidized glutathione due to reduced nicotinamide adenine dinucleotide phosphate (NADPH), with increased muscle catabolism. Critical illness polyneuropathy (CIP) was described about 30 years ago to be a rare complication of sepsis and multiorgan failure. The initial reports of cases had only a few cases of associated myopathy, mainly occurring in conjuncture with prolonged use of NMBAs and steroids in the required settings.10 There is recent literature on myopathies occurring in patients who have had no exposure to th