Intensive Care Unit–Acquired Weakness: Implications for Physical Therapist Management

Abstract

<jats:p>Patients admitted to the intensive care unit (ICU) can develop a condition referred to as “ICU-acquired weakness.” This condition is characterized by profound weakness that is greater than might be expected to result from prolonged bed rest. Intensive care unit–acquired weakness often is accompanied by dysfunction of multiple organ systems. Individuals with ICU-acquired weakness typically have significant activity limitations, often requiring physical assistance for even the most basic activities associated with bed mobility. Many of these individuals have activity limitations months to years after hospitalization. The purpose of this article is to review evidence that guides physical rehabilitation of people with ICU-acquired weakness. Included are diagnostic criteria, medical management, and prognostic indicators, as well as criteria for beginning physical rehabilitation, with an emphasis on patient safety. Data are presented indicating that rehabilitation can be implemented with very few adverse effects. Evidence is provided for appropriate measurement approaches and for physical intervention strategies. Finally, some of the key issues are summarized that should be investigated to determine the best intervention guidelines for individuals with ICU-acquired weakness.</jats:p>

Sarcopenia in critically ill patients

“…Values of <11 kg force for men and <7 kg force for women have been reported to identify ICU-AW in previously healthy individuals but these are not suitable for ICU patients because of immobilization, life-threatening illnesses and cooperation and consciousness problems from sedative medications [24]. Some non-volitional neurophysiologic and muscle strength assessment tests using electrical and magnetic stimulation techniques of peripheral nerves are available [25]; however, these tests are primarily research tools, and widespread use can be difficult in ICUs, as well as the need for experienced staff and expensive equipment.…”

Clinical review: Early patient mobilization in the ICU

“…In patients requiring mechanical ventilation for longer than 7 days, the incidence of ICU-acquired (neuromuscular) weakness is reported to be between 25 and 60% (Table 1) [1,7,8]. Such weakness may contribute to increased duration of mechanical ventilation, increased length of stay in the ICU and hospital, and poor quality of life among survivors [9-11].…”

Feasibility and Efficacy of Function-Focused Care for Orthopedic Trauma Patients

“…Orthostatic hypotension is often considered a risk factor for getting patients up when hospitalized (Nordon-Craft, Moss, Quan, & Schenkman, 2012) and pain and weakness make patients unwilling and unable to transfer out of bed. Increasingly, mechanical lifts are used which likewise propagate further weakening as this limits the activity that patients would otherwise participate in during transfers.…”