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In Reply: We agree with Dr Latronico that the occurrence of simultaneous axon and muscle involvement in critical illness neuromuscular abnormalities (CINMA) is not novel. This finding has been previously identified in 2 prospective cohort studies of ICU patients with systematic electrophysiological and muscle histological examination.^1-2 In our study, electrophysiological examination and muscle biopsy were only performed in patients with clinical paresis at awakening after the acute phase of their illness, which confirmed that clinical weakness was associated with both axonal and muscle involvement.

We also agree with Latronico that the severity of the underlying disease is a major contributing factor in ICUAP as was shown by our logistic regression analysis that identified both duration of mechanical ventilation and the number of days with dysfunction in 2 or more organs before awakening as independent predictors of ICUAP. However, we do not agree with Dr Ahmed and colleagues that severe or . . . [Full Text of this Article]

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