ICU-acquired weakness

Abstract

Critically ill patients often acquire neuropathy and/or myopathy labeled ICU-acquired weakness. The current insights into incidence, pathophysiology, diagnostic tools, risk factors, short-and long-term consequences and management of ICU-acquired weakness are narratively reviewed. PubMed was searched for combinations of "neuropathy", "myopathy", "neuromyopathy", or "weakness" with "critical illness", "critically ill", "ICU", "PICU", "sepsis" or "burn". ICU-acquired weakness affects limb and respiratory muscles with a widely varying prevalence depending on the study population. Pathophysiology remains incompletely understood but comprises complex structural/functional alterations within myofibers and neurons. Clinical and electrophysiological tools are used for diagnosis, each with advantages and limitations. Risk factors include age, weight, comorbidities, illness severity, organ failure, exposure to drugs negatively affecting myofibers and neurons, immobility and other intensive care-related factors. ICU-acquired weakness increases risk of in-ICU, in-hospital and long-term mortality, duration of mechanical ventilation and of hospitalization and augments healthcare-related costs, increases likelihood of prolonged care in rehabilitation centers and reduces physical function and quality of life in the long term. RCTs have shown preventive impact of avoiding hyperglycemia, of omitting early parenteral nutrition use and of minimizing sedation. Results of studies investigating the impact of early mobilization, neuromuscular electrical stimulation and of pharmacological interventions were inconsistent, with recent systematic reviews/meta-analyses revealing no or only low-quality evidence for benefit. ICU-acquired weakness predisposes to adverse short-and long-term outcomes. Only a few preventive, but no therapeutic, strategies exist. Further mechanistic research is needed to identify new targets for interventions to be tested in adequately powered RCTs.

Organ-specific manifestations of COVID-19 infection

“…Neurological symptoms caused by systemic illness especially in severely ill patients could also justify neurological manifestations of COVID-19 infection [ 114 ]. Patients admitted to intensive care unit (ICU) often develop encephalopathy, myopathy, autonomic neuropathy and polyneuromyopathy related to critical illness [ 124 ].…”

Critical illness myopathy after COVID-19

“…Notably, large numbers of patients with COVID-19 require intensive care unit (ICU) admission and long stays ( Lewnard et al, 2020 ). Critically ill patients are likely to develop muscular complications, such as critical illness myopathy (CIM), which adversely affect short-term and long-term outcomes ( Vanhorebeek et al, 2020 ). This report describes neurophysiological findings from a patient who developed severe muscular weakness, likely due to CIM, after hospitalisation for COVID-19.…”

Facing acute neuromuscular diseases during COVID-19 pandemic: focus on Guillain–Barré syndrome

“…CIP and CIM are complications of critical illness that are present in ICU patients with muscle weakness and weaning failure after ventilation [69]. Muscle weakness is frequent in ICU patients with a reported median prevalence of 43% (interquartile range 27-75%) over 31 studies [69].…”

“…CIP and CIM are complications of critical illness that are present in ICU patients with muscle weakness and weaning failure after ventilation [69]. Muscle weakness is frequent in ICU patients with a reported median prevalence of 43% (interquartile range 27-75%) over 31 studies [69]. The need of a differential diagnosis between GBS and CIP or CIM was considered and discussed by Kim et al [15] in four patients with MERS coronavirus infection.…”