Acquired neuromuscular weakness In Intensive Care Unit: Review article

Abstract

A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as "intensive care unit acquired weakness" (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy. ICUAW is typically symmetrical and affects predominantly proximal limb muscles and respiratory muscles, whereas facial and ocular muscles are often spared. ICUAW is diagnosed in awake and cooperative patients by bedside manual testing of muscle strength and the severity is scored by the Medical Research Council sum score. In cases of atypical clinical presentation or evolution, additional electrophysiological testing may be required for differential diagnosis. The cornerstones of prevention are aggressive treatment of sepsis, early mobilization, preventing hyperglycemia with insulin, and avoiding the use parenteral nutrition during the first week of critical illness. Future research should focus on new preventive and/or therapeutic strategies for this detrimental complication of critical illness and on clarifying how ICUAW contributes to poor longer-term prognosis.

Muscle strength/intensive care unit acquired weakness in COVID‐19 and non‐COVID‐19 patients

“…However, direct muscle injury caused by COVID‐19 has been reported in some viral infections, such as influenza, 45 human immunodeficiency virus 46 and SARS, 34 but studies have not proven direct muscle injury induced by the virus. Studies have shown that microvascular, electrical, metabolic, and bioenergetic changes interact in complex ways and cause muscle weakness or atrophy 47 . According to the present study, it is not possible to determine the effects of the disease on different muscle types.…”