Acquired Neuromuscular Weakness and Early Mobilization in the Intensive Care Unit

Abstract

Survival from critical illness has improved in recent years, leading to increased attention to the sequelae of such illness. Neuromuscular weakness in the intensive care unit (ICU) is common, persistent, and has significant public health implications. The differential diagnosis of weakness in the ICU is extensive and includes critical illness neuromyopathy. Prolonged immobility and bedrest lead to catabolism and muscle atrophy, and are associated with critical illness neuromyopathy and ICU-acquired weakness. Early mobilization therapy has been advocated as a mechanism to prevent ICU-acquired weakness. Early mobilization is safe and feasible in most ICU patients, and improves outcomes. Implementation of early mobilization therapy requires changes in ICU culture, including decreased sedation and bedrest. Various technologies exist to increase compliance with early mobilization programs. Drugs targeting muscle pathways to decrease atrophy and muscle-wasting are in development. Additional research on early mobilization in the ICU is needed.

Skeletal Muscle Dysfunction in Critical Illness

“…There have been several reports that early rehabilitation is safe and feasible even in the early phase in the ICU, and is beneficial for reducing ICU and hospital stay [115,116]. RCT comparing "cycling exercise 20 minutes at the bedside every day" and "standard physical therapy" during ICU stay did not report the occurrence of muscle weakness, but the isometric knee extensor strength and 6-minute walking distance were significantly higher in the intervention group [117].…”

A review of blisters caused by wound dressing components: Can they impede post-operative rehabilitation and discharge?

“…The physiological impact of surgical stress is wide, and includes muscle atrophy (Bautmans et al, 2014). Early mobilisation as part of a multimodal response of patient has also been claimed to prevent such atrophy of muscles (Lipshutz and Gropper, 2013). 3.…”

Optimizing sedation in the ICU: the eCASH concept

“…(17) Restricted mobilization of ICU patients as a result of deep sedation is likely to increase the development of ICU-acquired weakness (18,19), which can have prolonged effects on long-term outcomes. (20) In a study of 192 patients in 12 ICUs in New Zealand and Australia in 2012/2013, two-thirds of patients were "deeply" sedated (Richmond Agitation Sedation Scale [RASS] -3 to -5) and two-thirds of the patients did not receive early mobilization; the main reason for lack of mobilization was the degree of sedation.…”