Intensive care unit acquired weakness

Abstract

In the last 15 years, the rapid development of therapeutic agents in intensive care has resulted in increased numbers of intensive care unit (ICU) survivors, leading to the need to study the long term complications of ICU stay. ICU survivors often exhibit significant muscle weakness with reduced functional ability and consequently reduced quality of life long after their ICU discharge. The term introduced to characterize this neuromuscular weakness is “intensive care unit acquired weakness” (ICUaW) which refers to a specific clinical diagnosis. ICUaW is attributed to a number of factors including disturbances of the microcirculation, the systemic inflammatory response syndrome (SIRS), sepsis and the use of drugs with a deleterious effect on the muscles, nerves and or neuromuscular junction. The incidence of ICUaW has been reported to range from 25% for patients clinically evaluated for the presence of ICUaW, to 50% when only electrophysiological criteria are used, and it depends on the type and severity of the illness for which ICU hospitalization was needed. No effective preventive or therapeutic strategy has been reported for this condition to date, apart from avoidance of known risk factors, early mobilization and, following encouraging results from recent studies, the use of electrical neuromuscular stimulation (ENMS). This review demonstrates the significance of the disease and outlines the causes of ICUaW, the diagnostic methods used, its short and long term impact and suggested preventive methods.