ICU-Acquired Weakness

Abstract

Survivorship after critical illness is an increasingly important health-care concern as ICU use continues to increase while ICU mortality is decreasing. Survivors of critical illness experience marked disability and impairments in physical and cognitive function that persist for years after their initial ICU stay. Newfound impairment is associated with increased health-care costs and use, reductions in health-related quality of life, and prolonged unemployment. Weakness, critical illness neuropathy and/or myopathy, and muscle atrophy are common in patients who are critically ill, with up to 80% of patients admitted to the ICU developing some form of neuromuscular dysfunction. ICU-acquired weakness (ICUAW) is associated with longer durations of mechanical ventilation and hospitalization, along with greater functional impairment for survivors. Although there is increasing recognition of ICUAW as a clinical entity, significant knowledge gaps exist concerning identifying patients at high risk for its development and understanding its role in long-term outcomes after critical illness. This review addresses the epidemiologic and pathophysiologic aspects of ICUAW; highlights the diagnostic challenges associated with its diagnosis in patients who are critically ill; and proposes, to our knowledge, a novel strategy for identifying ICUAW.

Compound muscle action potential duration in critical illness neuromyopathy

“…After approval had been obtained from the Mayo Clinic institutional review board, we retrospectively identified 58 patients from the Mayo Clinic Rochester and Arizona databases who were diagnosed with CINM, using clinical and electrodiagnostic criteria. [2][3][4][5] We chose to define our experimental cohort operationally as having CINM in light of the high incidence of co-occurrence of CIM and CIP, [8][9][10][11][12] because of the difficulty in definitively distinguishing the entities clinically and electrophysiologically (particularly in mild cases of CIM and/or CIP) in the ICU environment, and due to the nonstandardized timing of the nerve conduction studies (NCSs) and electromyography (EMG) stemming from the inherent nature of our retrospective study. Nevertheless, we attempted to distinguish between patients who had predominantly CIM versus CIP based on the expert clinician's final diagnosis after synthesizing elements of the history, neurological examination, and electrophysiological testing.…”

“…1 The disease commonly manifests as a flaccid quadriparesis with respiratory weakness and is thought to arise primarily from the downstream effects of systemic inflammation. [2][3][4][5] The term encompasses the entities critical illness polyneuropathy (CIP) 6 and critical illness myopathy (CIM), 7 which commonly co-occur along a proportional spectrum in the individual patient. [8][9][10][11][12] Prompt and accurate recognition of CINM is important to avoid unnecessary workup, to provide prognostic information to families, and to ensure that measures are employed to reduce risk factors.…”

“…Critical illness neuromyopathy (CINM) is the most common condition causing secondary neuromuscular weakness in critically ill patients . The disease commonly manifests as a flaccid quadriparesis with respiratory weakness and is thought to arise primarily from the downstream effects of systemic inflammation . The term encompasses the entities critical illness polyneuropathy (CIP) and critical illness myopathy (CIM), which commonly co‐occur along a proportional spectrum in the individual patient …”

Abstracts

“…Bersano E 1 , Dalla Bella E 1 , Consonni M 1 , Pensato V 2 , Gellera C 2 , Lombardi R 3 , Lauria G 1,3 ruled out malignancies. Treatment with rituximab was withdrawn because of severe allergic reaction; IVIG provided benefit on sensory symptoms.…”

The provision of nurse‐led follow‐up at Norwegian intensive care units

“…The burden of recovery after critical care has both physical and psychosocial dimensions. Symptoms of intensive care unit acquired weakness (ICUAW) are among the most commonly reported physical health limitations, and up to 80% of ICU patients develop some kind of neuromuscular dysfunction (Jolley, Bunnell, & Hough, 2016).…”