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To the Editor: Dr De Jonghe and colleagues¹ diagnosed ICUAP based on a bedside clinical examination in patients who regained consciousness after long-term mechanical ventilation. The authors questioned the reliability and the necessity of electrophysiological testing to detect ICUAP.

In contrast, we recommend initial electrophysiological testing for diagnosis of ICUAP in the early clinical course of intensive care unit (ICU) patients, if bedside neurological examination cannot be performed due to use of sedatives and analgesics.^2-3 Many patients receiving mechanical ventilation are also given sedatives and analgesics. It is important to assess for muscular paresis, which could interfere with early spontaneous breathing and lead to weaning failure. Thus, early electrophysiological testing as a diagnostic tool for ICUAP has great clinical value.

De Jonghe et al found that risk of ICUAP was significantly associated with use of corticosteroids. The authors, however, mentioned neither dose nor duration of corticosteroid therapy. In their study, . . . [Full Text of this Article]

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