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Pathogenesis of underlying critical illness polyneuromyopathy (CIPNM) remains incompletely understood. This exploratory study investigated whether longitudinal neuromuscular ultrasound examinations and cytokine analyses in correlation to classical clinical and electrophysiological assessment contribute to the understanding of CIPNM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Intensive care unit patients were examined every 7 days until discharge from hospital. Clinical status, nerve conduction studies, electromyography as well as ultrasound of peripheral nerves and tibial anterior muscle were performed. Cytokine levels were analyzed by a bead-based multiplex assay system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 248 screened patients, 35 patients were included at median of 6\u00a0days (IQR: 8) after admission to intensive care unit. Axonal damage was the main feature of CIPNM. At the peak of CIPNM (7\u00a0days after inclusion), nerve ultrasound showed cross-sectional area increase of tibial nerve as a sign of inflammatory edema as well as hypoechoic nerves as a possible sign of inflammation. Cytokine analyses showed signs of monocyte and macrophage activation at this stage. Fourteen\u00a0days after inclusion, cytokines indicated systemic immune response as well as profiles associated to neovascularization and regeneration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Exploratory neuromuscular ultrasound and cytokine analyses showed signs of inflammation like macrophage and monocyte activation at the peak of CIPNM followed by a systemic immune response parallel to axonal damage. This underlines the role of both axonal damage and inflammation in pathogenesis of CIPNM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12028-020-01148-2","type":"journal-article","created":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T16:20:00Z","timestamp":1606234800000},"page":"139-152","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["New Approaches to Critical Illness Polyneuromyopathy: High-Resolution Neuromuscular Ultrasound Characteristics and Cytokine Profiling"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0493-8656","authenticated-orcid":false,"given":"Anna Lena","family":"Fisse","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"May","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremias","family":"Motte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiomara","family":"Pedreiturria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas G. 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Caroline May received funding from PURE (Protein Research Unit Ruhr within Europe, a project of North Rhine Westphalia, a federal German state) and deNBI, a project of the German Federal ministry of Education and Research [FKZ031A534A], none related to this work. Jeremias Motte received travel grants from Biogen idec, Novartis AG, Teva and Eisai GmbH; his research is funded by Klaus Tschira Foundation and Ruhr-University, Bochum (FoRUM-program), none related to this work. Xiomara Pedreiturria: none. Thomas G. K. Breuer: none. Christiane Schneider-Gold received consulting and speaker\u2019s honoraria from Alexion Pharmaceuticals, Amicus Therapeutics, Bayer Schering, CSL Behring, Gr\u00fcnenthal, Lupin Pharmaceuticals, and TEVA. Katrin Marcus received funding from PURE (Protein Research Unit Ruhr within Europe, a project of North Rhine Westphalia, a federal German state) and deNBI, a project of the German Federal ministry of Education and Research [FKZ031A534A], none related to this work. Ralf Gold received consultation fees and speaker honoraria from Bayer Schering, Biogen idec, Merck Serono, Novartis, Sanofi-Aventis and TEVA. He also acknowledges grant support from Bayer Schering, Biogen idec, Merck Serono, Sanofi-Aventis and TEVA, none related to this manuscript. Min-Suk Yoon received speakers\u2019 honoraria from CSL Behring, Grifols and scientific grant from CSL Behring. Kalliopi Pitarokoili received travel grants and speakers\u2019 honoraria from Novartis, Biogen idec, Teva, Bayer, CSL Behring and Grifols all not related to the manuscript.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The ethics committee of the medical faculty of the Ruhr University Bochum approved our study protocol (vote no. 16-5994).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval and Consent to Participate"}},{"value":"Written informed consent was obtained by patients or their legal representatives.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Open Access funding enabled and organized by Projekt DEAL.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}}]}}