ICU Acquired Weakness: Difference between revisions
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Critical ill patients often develop neuromuscular disorders such as Critical Illness Polyneuropathy (CIP) and Critical Illness Myopathy (CIM) called Intensive Care Unit Acquired weakness (ICUAW).<ref>Vanhorebeek I, Latronico N, Van den Berghe G. [https://link.springer.com/article/10.1007/s00134-020-05944-4 ICU-acquired weakness.] Intensive Care Medicine. 2020 Feb 19:1-7.</ref><ref name=":0">Judemann K, Lunz D, Zausig YA, Graf BM, Zink W. [https://www.ncbi.nlm.nih.gov/pubmed/22006117 Intensive care unit-acquired weakness in the critically ill: critical illness polyneuropathy and critical illness myopathy]. Der Anaesthesist. 2011 Oct;60(10):887-901.</ref> One of ICUAW's implications is that it causes generalized muscle weakness with more affectation on the limbs and respiratory muscles, leading to delays in mobilization and prolongation of hospitalization.<ref name=":0" /><ref>Hermans G, Van den Berghe G. [https://ccforum.biomedcentral.com/articles/10.1186/s13054-015-0993-7#Sec1 Clinical review: intensive care unit acquired weakness]. Critical care. 2015 Dec;19(1):274.</ref> There are several diseases that make people with illness worsen to the extent of need for ICU use. One of these diseases is COVID-19, which affects the respiratory system and leaves a person with this condition using a ventilator or ICU. Knowledge of ICUAW among clinicians such as physiotherapists will therefore enhance effective delivery of healthcare to ICU patients such as patient with COVID 19. This paper will therefore examine the literature on ICUAW and mamagement, which will include the role of physiotherapy. | Critical ill patients often develop neuromuscular disorders such as Critical Illness Polyneuropathy (CIP) and Critical Illness Myopathy (CIM) called Intensive Care Unit Acquired weakness (ICUAW).<ref>Vanhorebeek I, Latronico N, Van den Berghe G. [https://link.springer.com/article/10.1007/s00134-020-05944-4 ICU-acquired weakness.] Intensive Care Medicine. 2020 Feb 19:1-7.</ref><ref name=":0">Judemann K, Lunz D, Zausig YA, Graf BM, Zink W. [https://www.ncbi.nlm.nih.gov/pubmed/22006117 Intensive care unit-acquired weakness in the critically ill: critical illness polyneuropathy and critical illness myopathy]. Der Anaesthesist. 2011 Oct;60(10):887-901.</ref> One of ICUAW's implications is that it causes generalized muscle weakness with more affectation on the limbs and respiratory muscles, leading to delays in mobilization and prolongation of hospitalization.<ref name=":0" /><ref>Hermans G, Van den Berghe G. [https://ccforum.biomedcentral.com/articles/10.1186/s13054-015-0993-7#Sec1 Clinical review: intensive care unit acquired weakness]. Critical care. 2015 Dec;19(1):274.</ref> There are several diseases that make people with illness worsen to the extent of need for ICU use. One of these diseases is COVID-19, which affects the respiratory system and leaves a person with this condition using a ventilator or ICU. Knowledge of ICUAW among clinicians such as physiotherapists will therefore enhance effective delivery of healthcare to ICU patients such as patient with COVID 19. This paper will therefore examine the literature on ICUAW and mamagement, which will include the role of physiotherapy. | ||
== | == Pathophysiology of ICU Acquired Weakness == | ||
There are several muscular changes in critically ill patients. Distortion of protein to DNA ratio, muscle protein synthesis and catabolic proteolysis, which explains some of the generalized muscle weakness in the acute phase of a person who is critically ill<ref name=":1">Hodgson CL, Tipping CJ. [https://www.sciencedirect.com/science/article/pii/S183695531630090X Physiotherapy management of intensive care unit-acquired weakness.] Journal of physiotherapy. 2017 Jan 1;63(1):4-10.</ref>. Not only does bed rest contribute to muscle loss in critically ill patients ICUAW leads to muscle protein synthesis and muscle mass reduction and increases muscle catabolism<ref name=":1" />. This contributes to less strength generated by muscle fiber and muscle wastage. The three ways in which ICUAW occurs in critically ill patients are polyneuropathy, myopathy, and/or muscle atrophy<ref name=":2">Jolley SE, Bunnell AE, Hough CL. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103015/#bib6 ICU-acquired weakness]. Chest. 2016 Nov 1;150(5):1129-40.</ref>. The characteristics of a person with critical illness polyneuropathy (CIP) are symmetrical, distal sensory-motor axonal polyneuropathy, which manifests in the affection of limbs and respiratory muscles and may also affect sensory and autonomic nerves<ref name=":2" />. Those with critical illness myopathy (CIM) showed limb and respiratory muscle weakness without affecting sensory function. These three manifestations (muscle atrophy, CIM, CIP) may overlap in occurrence and therefore the manifestation of ICUAW varies between different patients<ref name=":2" />. <br> | |||
== Clinical Presentation == | == Clinical Presentation == | ||
Revision as of 12:58, 9 April 2020
Original Editor - Tolulope ADENIJI.
Top Contributors - Tolulope Adeniji, Lucinda hampton, Vidya Acharya, Kim Jackson and Natalie Patterson
Introduction[edit | edit source]
Critical ill patients often develop neuromuscular disorders such as Critical Illness Polyneuropathy (CIP) and Critical Illness Myopathy (CIM) called Intensive Care Unit Acquired weakness (ICUAW).[1][2] One of ICUAW's implications is that it causes generalized muscle weakness with more affectation on the limbs and respiratory muscles, leading to delays in mobilization and prolongation of hospitalization.[2][3] There are several diseases that make people with illness worsen to the extent of need for ICU use. One of these diseases is COVID-19, which affects the respiratory system and leaves a person with this condition using a ventilator or ICU. Knowledge of ICUAW among clinicians such as physiotherapists will therefore enhance effective delivery of healthcare to ICU patients such as patient with COVID 19. This paper will therefore examine the literature on ICUAW and mamagement, which will include the role of physiotherapy.
Pathophysiology of ICU Acquired Weakness[edit | edit source]
There are several muscular changes in critically ill patients. Distortion of protein to DNA ratio, muscle protein synthesis and catabolic proteolysis, which explains some of the generalized muscle weakness in the acute phase of a person who is critically ill[4]. Not only does bed rest contribute to muscle loss in critically ill patients ICUAW leads to muscle protein synthesis and muscle mass reduction and increases muscle catabolism[4]. This contributes to less strength generated by muscle fiber and muscle wastage. The three ways in which ICUAW occurs in critically ill patients are polyneuropathy, myopathy, and/or muscle atrophy[5]. The characteristics of a person with critical illness polyneuropathy (CIP) are symmetrical, distal sensory-motor axonal polyneuropathy, which manifests in the affection of limbs and respiratory muscles and may also affect sensory and autonomic nerves[5]. Those with critical illness myopathy (CIM) showed limb and respiratory muscle weakness without affecting sensory function. These three manifestations (muscle atrophy, CIM, CIP) may overlap in occurrence and therefore the manifestation of ICUAW varies between different patients[5].
Clinical Presentation[edit | edit source]
add text here relating to the clinical presentation of the condition
Diagnostic Procedures[edit | edit source]
add text here relating to diagnostic tests for the condition
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions[edit | edit source]
add text here relating to management approaches to the condition
Resources[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Medicine. 2020 Feb 19:1-7.
- ↑ 2.0 2.1 Judemann K, Lunz D, Zausig YA, Graf BM, Zink W. Intensive care unit-acquired weakness in the critically ill: critical illness polyneuropathy and critical illness myopathy. Der Anaesthesist. 2011 Oct;60(10):887-901.
- ↑ Hermans G, Van den Berghe G. Clinical review: intensive care unit acquired weakness. Critical care. 2015 Dec;19(1):274.
- ↑ 4.0 4.1 Hodgson CL, Tipping CJ. Physiotherapy management of intensive care unit-acquired weakness. Journal of physiotherapy. 2017 Jan 1;63(1):4-10.
- ↑ 5.0 5.1 5.2 Jolley SE, Bunnell AE, Hough CL. ICU-acquired weakness. Chest. 2016 Nov 1;150(5):1129-40.
