In six patients, either the CIM or CIP score selleck bio was not available, and one patient did not show signs of CIM or of CIP at baseline. Age, length of ICU stay, Sequential Organ Failure Assessment score (SOFA) score, APACHE III score and mortality were similar between patients having CIM, CIP or combined CIP/CIM.EPS and histological assessment could not be performed at some time points due to the following reasons: patient��s death (histology on Day 14 (6 times) and EPS on days 4, 7, 14 (10 times)), withdrawn consent (histology on day 14 (once)), prone position (EPS on days 4, 7, 14 (3 times)), insufficient muscle tissue in biopsy (histoogy on days 0 and 14 (3 times)), necrotizing fasciitis (EPS on days 0, 4 (twice)), dislocated fracture (EPS on days 4, 7, 14 (3 times)), or logistic reasons (EPS on days 4, 7 (18 times)).

DiscussionCIPNM is a serious complication of critically ill patients leading to muscle weakness and weaning failure. To date, no specific treatment has been proven in randomized controlled trials to prevent or mitigate CIPNM [1]. As there is evidence for a role of immune mechanisms in CIPNM [3], Wijdicks et al. administered IVIG in three patients, without beneficial effects [20]. However, in a retrospective analysis of 33 patients early administration of IgM-enriched IVIG was suggested to prevent CIPNM [15].The present study is the first prospective, randomized, double-blinded, placebo-controlled trial assessing the impact of IgM-enriched IVIG on CIPNM. To achieve a potentially optimal effect of IVIG, we included only severely ill patients with MOF, a SIRS/sepsis diagnosis and clinical signs of CIPNM.

However, IVIG did not mitigate CIPNM in the critically ill patients in the present trial. Neither CIP as determined by EPS of three nerves on days 0, 4, 7 and 14 nor CIM as assessed by the histological examination of muscle biopsies on days 0 and 14 were different in the IVIG group compared to the controls at any time point. Moreover, length of ICU stay and mortality were similar in both groups.More than two-thirds of the patients presented with both increased CIM and CIP scores while 16% had either elevated CIP or CIM scores. Thus, 97% of the patients (31/32) presented with CIPNM at baseline based on EPS and muscle histology findings. This is comparable to patients with severe sepsis [10].

As CIP and CIM are overlapping diseases, the CIP (CIM) score does not necessarily reflect severity of CIP (CIM) only, but should be seen as a marker of the severity of CIPNM.Mohr et al. found some evidence in a retrospective chart analysis of IVIG being able to prevent CIPNM in critically Entinostat ill patients using EPS [15]. Based on the retrospective character of their analysis, the evidence has been regarded as weak and is in contrast with findings of our prospective, randomized, double-blinded placebo-controlled trial. However, Mohr et al.