The incidence of intensive care unit-acquired weakness syndromes: A systematic review

Abstract

We conducted a literature review of the intensive care unit-acquired weakness syndromes (critical illness polyneuropathy, critical illness myopathy and critical illness neuromyopathy) with the primary objective of determining their incidence as a combined group. Studies were identified through MEDLINE, Embase, Cochrane Database and article reference list searches and were included if they evaluated the incidence of one or more of these conditions in an adult intensive care unit population. The incidence of an intensive care unit-acquired weakness syndrome in the included studies was 40% (1080/2686 patients, 95% confidence interval 38-42%). The intensive care unit populations included were heterogeneous though largely included patients receiving mechanical ventilation for seven or more days. Additional prespecified outcomes identified that the incidence of intensive care unit-acquired weakness varied with the diagnostic technique used, being lower with clinical (413/1276, 32%, 95% CI 30-35%) compared to electrophysiological techniques (749/1591, 47%, 95% CI 45-50%). Approximately a quarter of patients were not able to comply with clinical evaluation and this may be responsible for potential underreporting of this condition.

Post‐intensive care syndrome: its pathophysiology, prevention, and future directions

“…The diagnosis of ICU‐AW is made according to the Medical Research Council scale for grading the strength of various muscle groups in the upper and lower extremities, and a combined score of <48 in all testable muscle groups noted on more than two occasions separated by 24 h is diagnostic of ICU‐AW . The incidence of ICU‐AW is 40% in critically ill adult patients . Critical illness polyneuropathy is the most common category, followed by CINM, whereas CIP is individually rare .…”

“…The quadriplegia after‐effect of disease usually resolves after several weeks to several months; rarely, impairment of motor function in survivors can persist from several months to several years . The risk of ICU‐AW is associated with female sex, sepsis, catabolic state, multiorgan failure, systemic inflammatory response syndrome, long duration of mechanical ventilation, immobility, hyperglycemia, glucocorticoids, and neuromuscular blocking agents; however, a systematic review did not link glucocorticoids to this risk . No consensus has been established regarding effective interventions to improve outcomes of patients who develop ICU‐AW; however, preventive measures including early physical rehabilitation, neuromuscular electrical stimulation, and glucose control have been applied.…”

Risk factors for intensive care unit-acquired weakness: A systematic review and meta-analysis

“…Intensive care unit‐acquired weakness (ICUAW) is an acute neuromuscular impairment that occurs frequently in the context of critical illness. The incidence of ICUAW is around 40% in critically ill patients with multi‐organ failure, prolonged mechanical ventilation or sepsis . ICUAW is associated with delayed weaning, longer ICU and hospital stays, increased health care–related costs, and higher ICU‐ and hospitalization‐related mortality .…”

Exploring the Potential Effectiveness of Combining Optimal Nutrition With Electrical Stimulation to Maintain Muscle Health in Critical Illness: A Narrative Review

“…There is a growing population of survivors of critical illness, with almost 90% of patients surviving the initial insult of critical illness . However, approximately 50% of survivors may develop intensive care unit–acquired weakness (ICU‐AW) and suffer ongoing significant morbidity in terms of physical, cognitive, and psychological health . ICU‐AW refers to clinically detectable global muscle weakness that develops as a result of no specific etiology other than being critically unwell .…”