• critical illness polyneuropathy
• critical illness myopathy
• intensive care

Critical care therapy has advanced over the past two decades, treating more patients and providing more complex care. However, the improved survival from septic shock, adult respiratory distress syndrome (ARDS), and multiple organ system failure results in critically ill patients facing a spectrum of new complications secondary to both illness and treatment. A third of intensive care unit (ICU) admissions have a neurological complication detrimental to outcome.¹ Neurological status (mainly depressed consciousness) is the major contributor to prolonged ventilation in a third of those who need it and is a significant factor in an additional 40%. Neurological complications double both the length of stay in hospital and the likelihood of death; the mortality rate for patients with neurological complications is 55% compared to 29% for those without. It is therefore unsurprising that neurologists are being increasingly called upon to review patients on the medical intensive care unit (MICU).

A neurological opinion is usually requested:

• to assess neurological manifestations of the primary disease process

• to evaluate the consequences of critical care therapy

• to offer a prognosis, or

• determine brain death.

The neurologist must approach these complex patients in a logical, meticulous, and sensitive manner. There are obvious inherent difficulties in reviewing on the MICU:

• difficulties in communication (sedation/endotracheal tube)

• bulky case records and numerous investigation results (scans often “off-site”)

• a “Pandora’s box” of ICU terminology (ARDS, SIRS, MODS, etc)

• unfamiliarity with types and levels of respiratory support, anaesthetic agents, and neuromuscular blockade

• limitations of the clinical examination caused by sedation or neuromuscular blockade

• constraints in arranging further investigations (for example, availability of neurophysiology or ventilator/magnetic resonance imaging (MRI) compatibility)