ICU Acquired Weakness
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]
Common clinical presentation of ICUAW is a generalized, usually symmetrical, limb weakness. The proximal muscles are more affected than the distal muscles, however less affected are the facial and ocular muscles. The reduction of tendon reflexes, facial grimacing to painful stimulation without withdrawal of limbs is another clinical presentation. With CIP type ICUAW, sensations such as pain temperature and vibration may be impaired
Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Management / Interventions[edit | edit source]
add text here relating to management approaches to the condition
Resources[edit | edit source]
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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.
