Thursday, January 21, 2016

ICU associated muscle weakness

From a recent review:

A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as “intensive care unit acquired weakness” (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both..The main risk factors for ICUAW include high severity of illness upon admission, sepsis, multiple organ failure, prolonged immobilization, and hyperglycemia, and also older patients have a higher risk. The role of corticosteroids and neuromuscular blocking agents remains unclear..The cornerstones of prevention are aggressive treatment of sepsis, early mobilization, preventing hyperglycemia with insulin, and avoiding the use parenteral nutrition during the first week of critical illness.

Though aggressive blood glucose control seems to reduce this problem, the article points out that it is associated with worse outcomes overall, and therefore no strong recommendation for glycemic control is made. The role of corticosteroids and neuromuscular blocking agents in this syndrome is not as clear as was once thought.

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