Critical illness weakness: Common questions

Linos, Konstantinos; Foot, Carole; Ziegenfuss, Marc; Freeman, W. David; Tan, K. Meng

doi:10.1016/j.cacc.2007.10.005

Cited by 8 publications

(10 citation statements)

References 50 publications

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“…1 Although isolated CIP remains a controversial entity that is likely rare, the incidence of CIM and CIPNM is reported from 25% to 83% depending on the underlying critical illness. 2,3 This diagnosis is typically entertained only when patients fail to wean from ventilatory support, and the true time of onset is often uncertain given concurrent encephalopathy, sedation, and possible paralysis. Up to 62% of patients who experience failure to wean from the ventilator have some form of neuromuscular weakness.…”

Section: Introductionmentioning

confidence: 99%

Review of Critical Illness Myopathy and Neuropathy

Shepherd

Batra

Lerner

2016

The Neurohospitalist

134

141

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Critical illness myopathy (CIM) and neuropathy are underdiagnosed conditions within the intensive care setting and contribute to prolonged mechanical ventilation and ventilator wean failure and ultimately lead to significant morbidity and mortality. These conditions are often further subdivided into CIM, critical illness polyneuropathy (CIP), or the combination-critical illness polyneuromyopathy (CIPNM). In this review, we discuss the epidemiology and pathophysiology of CIM, CIP, and CIPNM, along with diagnostic considerations such as detailed clinical examination, electrophysiological studies, and histopathological review of muscle biopsy specimens. We also review current available treatments and prognosis. Increased awareness and early recognition of CIM, CIP, and CIPNM in the intensive care unit setting may lead to earlier treatments and rehabilitation, improving patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Review of Critical Illness Myopathy and Neuropathy

Shepherd

Batra

Lerner

2016

The Neurohospitalist

134

141

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“…Critical illness myopathy (CIM), critical illness polyneuropathy (CIP), or both (critical illness polyneuromyopathy [CIPNM]) during the course of critical illness are the most common causes of neuromuscular weakness in ICUAW, which is frequently implicated in reduced physical function due to quadriplegia and failure to wean from the ventilator [3]. Although the onset of isolated CIP is still controversial, the incidence of CIM and CIPNM has been reported to be 25%–83%, depending on the underlying critical illness [4,5].…”

Section: Icu-acquired Weaknessmentioning

confidence: 99%

Pulmonary and Physical Rehabilitation in Critically Ill Patients

Jang

Shin²,

Shin

2019

Acute Crit Care

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Some patients admitted to the intensive care unit (ICU) because of an acute illness, complicated surgery, or multiple traumas develop muscle weakness affecting the limbs and respiratory muscles during acute care in the ICU. This condition is referred to as ICU-acquired weakness (ICUAW), and can be evoked by critical illness polyneuropathy (CIP), critical illness myopathy (CIM), or critical illness polyneuromyopathy (CIPNM). ICUAW is diagnosed using the Medical Research Council (MRC) sum score based on bedside manual muscle testing in cooperative patients. The MRC sum score is the sum of the strengths of the 12 regions on both sides of the upper and lower limbs. ICUAW is diagnosed when the MRC score is less than 48 points. However, some patients require electrodiagnostic studies, such as a nerve conduction study, electromyography, and direct muscle stimulation, to differentiate between CIP and CIM. Pulmonary rehabilitation in the ICU can be divided into modalities intended to remove retained airway secretions and exercise therapies intended to improve respiratory function. Physical rehabilitation, including early mobilization, positioning, and limb exercises, attenuates the weakness that occurs during critical care. To perform mobilization in mechanically ventilated patients, pretreatment by removing secretions is necessary. It is also important to increase the strength of respiratory muscles and to perform lung recruitment to improve mobilization in patients who are weaned from the ventilator. For these reasons, pulmonary rehabilitation is important in addition to physical therapy. Early recognition of CIP, CIM, and CIPNM and early rehabilitation in the ICU might improve patients' functional recovery and outcomes.

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“…ICU‐AW is associated with certain illness characteristics (sepsis, systemic inflammatory syndrome, multi‐organ failure, hyperglycaemia) (Pandit & Agrawal , Linos et al . , Schweickert & Hall , Dyer et al . ), medication (corticosteroids and neuromuscular blocking agents) (Pandit & Agrawal , Linos et al .…”

Section: Physical Problemsmentioning

confidence: 99%

“…), medication (corticosteroids and neuromuscular blocking agents) (Pandit & Agrawal , Linos et al . , Schweickert & Hall ) and is positively associated with number of days in intensive care with two or more organ dysfunctions (Truong et al . ).…”

Section: Physical Problemsmentioning

confidence: 99%