A Case of Short- Term Intensive Care Unit-Acquired Weakness Post-Renal Graft Nephrectomy after Liver and Kidney Transplant

Abstract

Background: In this study, we shed the light on the effect of two short-term ICU admissions within short period in-between admissions and the undesirable results in core muscles, lower limb motor power and physical abilities. We emphasized the importance of early intervention of physical therapy during ICU admission and after. Case Report: This study involved a 58 years old female patient with CKD and liver cirrhosis long years ago, underwent living-donor kidney and liver transplant procedure in September 2021, and was admitted in ICU for one week. Few months later, investigation revealed poor kidney function and renal graft nephrectomy was done in December 2021. Patient was admitted one week in ICU after renal graft nephrectomy. Core muscles, lower limb muscles and physical abilities were measured pre and post ICU admission after renal graft nephrectomy and at the time of discharge from physical therapy service. Result: Motor power was measured before renal graft nephrectomy and ICU admission classified and measured as follows: core muscles, hip flexors, adductors and abductors graded 3/5, hams and quad graded 3+/5, patient was able to stand up from sitting on regular chair and able to walk without assistance. Post renal graft nephrectomy and ICU admission the MRC was as follows: core muscles, hip flexors, adductors and abductors graded 2-/5, hams and quad graded 3-/5, patient was unable to stand up from regular chair and has poor standing balance. Patient was followed up in physical therapy eight weeks in total, four weeks in in-patient setting and four week in OPD. The discharge assessment shows improvement in hams and quad motor power measured 4/5, good core muscles and hip muscles measured 4/5. Patient was ambulatory without assistive device at the time of discharge from physical therapy service. Conclusion: Short-term ICU admission can acquired weakness if patient has repeated ICU admissions within short period