Intensive Care Unit Acquired Weakness (ICU-AW): a brief and practical review

Abstract

Intensive care unit-acquired weakness (ICU-AW) is an increasingly complication of survivors of critical illness. It should be suspected in the presence of a patient with a flaccid tetraparesis or tetraplegia with hyporeflexia or absent deep tendon reflexes and difficult to weaning from mechanical ventilation in the absence of different diagnoses. Important risk factors are age, sepsis, illness duration and severity, some drugs (neuromuscular blockers, steroids). Electrophysiological studies have shown an axonal damage of involved peripheral nerves (critical illness polyneuropathy). However, muscle can also be primitively affected (critical illness myopathy) leading to ICU-AW with inconstant myopathic damage patterns in electromyographic studies. Mixed forms can are present (critical illness polyneuromyopathy. Although the pathophysiology remains obscure, the hypothesis of an acquired channelopathy is substantial. Electroneuromyography is crucial for diagnosis. Muscular and nerve biopsies are necessary for diagnosis confirmation. Aggressive treatment of baseline disease, prevention, through avoiding or minimizing precipitating factors, strict glycemic control, and early rehabilitation combining mobilization with physiotherapy and muscle electrical muscle stimulation, are the keys to improving recovery of the affected individuals. This narrative review highlights the current literature regarding the etiology and diagnosis of ICU-AW.

Acquired neuromuscular weakness In Intensive Care Unit: Review article

“…Patients exhibiting fixed or focal motor defects or persistent altered sensorium despite adequate sedation washout should undergo more advanced diagnostics (i.e., CNS imaging, electrophysiologic studies, and/or muscle biopsy), ( Figure 4). [26] The decision to perform electrophysiologic testing and/or muscle biopsy in routine care has created an ongoing debate in the medical literature about its utility. Advocates for routine clinical examination who reserve neurophysiological testing and biopsy for unusual or severe instances of weakness cite the limitations, costs, and risks of this testing is a useful and efficient strategy.…”

“…Several attempts at controlling early stage of the SIRS have shown variable results. [26] These attempts include monoclonal and polyclonal antibodies directed against bacterial endotoxin, monoclonal antibodies to tumor necrosis factor-alpha, fusion protein constructs of soluble tumor necrosis factor receptors, IL-1 receptor antagonists, the platelet activating factor receptor antagonist, BN5202, and the N-acetylcysteine. There also was no beneficial effect of reducing disease severity using high intravenous immunoglobulins,[34] and IgM-enriched intravenous immunoglobulin.…”

“…It is advisable as far as possible to implement protocols of daily interruption of sedation, in order to withdrawal as quickly as possible. [26] De Jonghe et al noted that use of a sedation algorithm designed to allow patients to be more alert was associated with a 50% reduction in pressure sores, presumably because of reductions in sedative-related immobilization.…”

“…Insulin exerts anti-inflammatory effects, endothelial protection, improvement of dyslipidemia, and neuroprotective effects in animals and is also an anabolic hormone. [26] Although intensive glucose control was earlier thought to be helpful in reducing the incidence and severity of critical illness polyneuropathy, the NICE-SUGAR Study argues against tight glucose control given the higher mortality risk associated with increased moderate to severe hypoglycemia. [38] Intensive insulin therapy should be avoided due to the risk of hypoglycemia.…”

Validez y confiabilidad de las escalas de evaluación funcional en pacientes críticamente enfermos. Revisión sistemática

“…Entre las principales consecuencias de la DAU-CI se encuentran el retardo en el destete de ventilación mecánica (VM) y aumento, tanto del tiempo de estadía en UPC, como de la morbimortalidad hospitalaria y de los costos 19,20 . Adicionalmente, la DAUCI se ha asociado al desacondicionamiento cardiorrespiratorio y muscular 2,4,21,22 , afectando significativamente el desempeño funcional y calidad de vida de los pacientes; lo cual ha sido evidenciado hasta 5 años después del alta hospitalaria 5,6,[22][23][24][25][26][27] . Por este motivo, el desarrollo de instrumentos que permitan cuantificar de forma certera la magnitud del deterioro funcional en este tipo de pacientes es crucial para el desarrollo de estrategias terapéuticas apropiadas, dirigidas a atenuar el deterioro funcional asociado a la enfermedad crítica.…”