Skeletal Muscle Dysfunction in Critical Illness

Abstract

Despite improvements in critical illness survival rates with recent developments in medical care, many patients still have long-term physical disabilities following stays in the intensive care unit (ICU). Critical illness-induced muscle weakness, so-called ICU-acquired weakness (ICU-AW), is a common occurrence in approximately 50% of critically ill patients in the ICU requiring mechanical ventilation for >7 days. ICU-AW contributes to increases in duration of mechanical ventilation and lengths of ICU and hospital stays and may persist among survivors for several years after discharge. Risk factors for ICU-AW include systemic inflammatory responses, severe sepsis, muscle inactivity, hyperglycemia, and use of neuromuscular blockers. Thus, the development of muscle wasting is suggested to be associated with pathophysiological alterations leading to an imbalance between muscle proteolysis and proteosynthesis through several cellular signaling networks. This chapter presents a review of the literature regarding critical illness-induced muscle wasting and describes potential treatment of excessive muscle catabolism.

Effect of Early Rehabilitation Activity Time on Critically Ill Patients with Intensive Care Unit-acquired Weakness: A Japanese Retrospective Multicenter Study

“…They reported that the intervention markedly improved the 6-min walking distance and lower limb muscle strength on discharge from the hospital. Similarly, Lida et al 22) examined critically ill patients requiring acute care, dividing them into the early (systemic inflammation from days 0 to 5) and late (inactivity after day 5) phases, and noted the necessity of considering appropriate exercise intensity levels in each phase.…”

Association between the early mobilization of mechanically ventilated patients and independence in activities of daily living at hospital discharge

“…However, in this study, medical and circulatory factors were not significantly associated with ADL independence at hospital discharge. Future studies should consider whether low and passive exercise 43 or neuromuscular electrical stimulation 44 can substitute for EM in patients who cannot achieve EM due to medical contraindications or cardiovascular factors. Previous studies have reported that factors related to the medical staff are a major barrier to mobilization [21][22][23] .…”

Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients

“…Most patients in this study may not have been able to tolerate mobilization, consistent with the expert consensus that it is difficult for patients to get out of bed or achieve mobilization during catecholamine therapy. 11 ) In the presence of circulatory instability, the mobilization rates are usually low, and passive exercise, 31 ) cycle ergometer exercise, 32 ) and neuromuscular electrical stimulation 33 ) may be used. Determination of the optimal rehabilitation level and duration before the patient achieves physiological stability should be the focus of future studies.…”