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Clinical review: intensive care unit acquired weakness

Greet Hermans, Greet Van den Berghe

Critical Care · 2015 · Review

Abstract

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. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy. ICUAW is typically symmetrical and affects predominantly proximal limb muscles and respiratory muscles, whereas facial and ocular muscles are often spared. 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. ICUAW is diagnosed in awake and cooperative patients by bedside manual testing of muscle strength and the severity is scored by the Medical Research Council sum score. In cases of atypical clinical presentation or evolution, additional electrophysiological testing may be required for differential diagnosis. 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. Weak patients clearly have worse acute outcomes and consume more healthcare resources. Recovery usually occurs within weeks or months, although it may be incomplete with weakness persisting up to 2 years after ICU discharge. Prognosis appears compromised when the cause of ICUAW involves critical illness polyneuropathy, whereas isolated critical illness myopathy may have a better prognosis. In addition, ICUAW has shown to contribute to the risk of 1-year mortality. Future research should focus on new preventive and/or therapeutic strategies for this detrimental complication of critical illness and on clarifying how ICUAW contributes to poor longer-term prognosis.

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References 117

1.
Osler W. Principles and practice of medicine. 1892.
Not in our library
2.
Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ. Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry. 1984;47:1223-31.
Not in our library10.1136/jnnp.47.11.1223
3.
Zochodne DW, Bolton CF, Thompson RT, Driedger AA, Hahn AF, Gilbert JJ. Myopathy in critical illness. Muscle Nerve. 1986;9:652.
Not in our library
4.
Bednarik J, Lukas Z, Vondracek P. Critical illness polyneuromyopathy: the electrophysiological components of a complex entity. Intensive Care Med. 2003;29:1505-14.
Not in our library10.1007/s00134-003-1858-0
5.
Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, Zawistowski C, Bemis-Dougherty A, Berney SC, Bienvenu OJ, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40:502-9.
Not in our library10.1097/ccm.0b013e318232da75
6.
Ali NA, O'Brien JM, Hoffmann SP, Phillips G, Garland A, Finley JC, Almoosa K, Hejal R, Wolf KM, Lemeshow S, et al. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008;178:261-8.
Not in our library10.1164/rccm.200712-1829oc
7.
Sharshar T, Bastuji-Garin S, Stevens RD, Durand MC, Malissin I, Rodriguez P, Cerf C, Outin H, De Jonghe B. Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality. Crit Care Med. 2009;37:3047-53.
Not in our library10.1097/ccm.0b013e3181b027e9
8.
De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, Cerf C, Renaud E, Mesrati F, Carlet J, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288:2859-67.
Not in our library10.1001/jama.288.22.2859
9.
Mirzakhani H, Williams JN, Mello J, Joseph S, Meyer MJ, Waak K, Schmidt U, Kelly E, Eikermann M. Muscle weakness predicts pharyngeal dysfunction and symptomatic aspiration in long-term ventilated patients. Anesthesiology. 2013;119:389-97.
Not in our library10.1097/aln.0b013e31829373fe
10.
Nanas S, Kritikos K, Angelopoulos E, Siafaka A, Tsikriki S, Poriazi M, Kanaloupiti D, Kontogeorgi M, Pratikaki M, Zervakis D, et al. Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit. Acta Neurol Scand. 2008;118:175-81.
Not in our library10.1111/j.1600-0404.2008.00996.x
11.
Hermans G, Van Mechelen H, Clerckx B, Vanhullebusch T, Mesotten D, Wilmer A, Casaer MP, Meersseman P, Debaveye Y, Van Cromphaut S, et al. Acute outcomes and 1-year mortality of ICU-acquired weakness: a cohort study and propensity matched analysis. Am J Respir Crit Care Med. 2014;190:410-20.
Not in our library10.1164/rccm.201312-2257oc
12.
Tzanis G, Vasileiadis I, Zervakis D, Karatzanos E, Dimopoulos S, Pitsolis T, Tripodaki E, Gerovasili V, Routsi C, Nanas S. Maximum inspiratory pressure, a surrogate parameter for the assessment of ICU-acquired weakness. BMC Anesthesiol. 2011;11:14.
Not in our library10.1186/1471-2253-11-14
13.
Bercker S, Weber-Carstens S, Deja M, Grimm C, Wolf S, Behse F, Busch T, Falke KJ, Kaisers U. Critical illness polyneuropathy and myopathy in patients with acute respiratory distress syndrome. Crit Care Med. 2005;33:711-5.
Not in our library10.1097/01.ccm.0000157969.46388.a2
14.
Fan E, Dowdy DW, Colantuoni E, Mendez-Tellez PA, Sevransky JE, Shanholtz C, Himmelfarb CR, Desai SV, Ciesla N, Herridge MS, et al. Physical complications in acute lung injury survivors: a 2-year longitudinal prospective study. Crit Care Med. 2013;42:849-59.
Not in our library10.1097/ccm.0000000000000040
15.
Latronico N, Fenzi F, Recupero D, Guarneri B, Tomelleri G, Tonin P, De Maria G, Antonini L, Rizzuto N, Candiani A. Critical illness myopathy and neuropathy. Lancet. 1996;347:1579-82.
Not in our library10.1016/s0140-6736(96)91074-0
16.
Fenzi F, Latronico N, Refatti N, Rizzuto N. Enhanced expression of E-selectin on the vascular endothelium of peripheral nerve in critically ill patients with neuromuscular disorders. Acta Neuropathol (Berl). 2003;106:75-82.
Not in our library10.1007/s00401-003-0704-3
17.
Bolton CF. Neuromuscular manifestations of critical illness. Muscle Nerve. 2005;32:140-63.
Not in our library10.1002/mus.20304
18.
Hermans G, Wilmer A, Meersseman W, Milants I, Wouters PJ, Bobbaers H, Bruyninckx F, Van den Berghe G. Impact of intensive insulin therapy on neuromuscular complications and ventilator-dependency in MICU. Am J Respir Crit Care Med. 2007;175:480-9.
Not in our library10.1164/rccm.200605-665oc
19.
Vanhorebeek I, De Vos R, Mesotten D, Wouters PJ, Wolf-Peeters C, Van den Berghe G. Protection of hepatocyte mitochondrial ultrastructure and function by strict blood glucose control with insulin in critically ill patients. Lancet. 2005;365:53-9.
Not in our library10.1016/s0140-6736(04)17665-4
20.
Van den Berghe G. How does blood glucose control with insulin save lives in intensive care? J Clin Invest. 2004;114:1187-95.
Not in our library10.1172/jci23506
21.
Novak KR, Nardelli P, Cope TC, Filatov G, Glass JD, Khan J, Rich MM. Inactivation of sodium channels underlies reversible neuropathy during critical illness in rats. J Clin Invest. 2009;119:1150-8.
Not in our library10.1172/jci36570
22.
Batt J, Dos Santos CC, Cameron JI, Herridge MS. Intensive care unit-acquired weakness: clinical phenotypes and molecular mechanisms. Am J Respir Crit Care Med. 2013;187:238-46.
Not in our library10.1164/rccm.201205-0954so
23.
Friedrich OR, Van den Berghe G, Van Horebeek I, Hermans G, Rich MM, Larsson L. The sick and the weak: neuropathies/myopathies in the critically ill—cellular mechanisms of complex disease entities in the ICU. Physiol Rev. 2015, in press.
Not in our library10.1152/physrev.00028.2014
24.
Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, Hopkinson NS, Phadke R, Dew T, Sidhu PS, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310:1591-600.
Not in our library10.1001/jama.2013.278481
25.
Derde S, Hermans G, Derese I, Guiza F, Hedstrom Y, Wouters PJ, Bruyninckx F, D'Hoore A, Larsson L, Van den Berghe G, et al. Muscle atrophy and preferential loss of myosin in prolonged critically ill patients. Crit Care Med. 2012;40:79-89.
Not in our library10.1097/ccm.0b013e31822d7c18
26.
Wollersheim T, Woehlecke J, Krebs M, Hamati J, Lodka D, Luther-Schroeder A, Langhans C, Haas K, Radtke T, Kleber C, et al. Dynamics of myosin degradation in intensive care unit-acquired weakness during severe critical illness. Intensive Care Med. 2014;40:528-38.
Not in our library10.1007/s00134-014-3224-9
27.
Bloch S, Polkey MI, Griffiths M, Kemp P. Molecular mechanisms of intensive care unit acquired weakness. Eur Respir J. 2012;39:1000-11.
Not in our library10.1183/09031936.00090011
28.
Weber-Carstens S, Schneider J, Wollersheim T, Assmann A, Bierbrauer J, Marg A, Al Hasani H, Chadt A, Wenzel K, Koch S, et al. Critical illness myopathy and GLUT4: significance of insulin and muscle contraction. Am J Respir Crit Care Med. 2013;187:387-96.
Not in our library10.1164/rccm.201209-1649oc
29.
Bloch SA, Lee JY, Syburra T, Rosendahl U, Griffiths MJ, Kemp PR, Polkey MI. Increased expression of GDF-15 may mediate ICU-acquired weakness by down-regulating muscle microRNAs. Thorax. 2015;70:219-28.
Not in our library10.1136/thoraxjnl-2014-206225
30.
Ackermann KA, Bostock H, Brander L, Schroder R, Djafarzadeh S, Tuchscherer D, Jakob SM, Takala J, Z'Graggen WJ. Early changes of muscle membrane properties in porcine faecal peritonitis. Crit Care. 2014;18:484.
Not in our library10.1186/s13054-014-0484-2
31.
Weber-Carstens S, Koch S, Spuler S, Spies CD, Bubser F, Wernecke KD, Deja M. Nonexcitable muscle membrane predicts intensive care unit-acquired paresis in mechanically ventilated, sedated patients. Crit Care Med. 2009;37:2632-7.
Not in our library10.1097/ccm.0b013e3181a92f28
32.
Rossignol B, Gueret G, Pennec JP, Morel J, Rannou F, Giroux-Metges MA, Talarmin H, Gioux M, Arvieux CC. Effects of chronic sepsis on contractile properties of fast twitch muscle in an experimental model of critical illness neuromyopathy in the rat. Crit Care Med. 2008;36:1855-63.
Not in our library10.1097/ccm.0b013e318176106b
33.
Zink W, Kaess M, Hofer S, Plachky J, Zausig YA, Sinner B, Weigand MA, Fink RH, Graf BM. Alterations in intracellular Ca2+−homeostasis of skeletal muscle fibers during sepsis. Crit Care Med. 2008;36:1559-63.
Not in our library10.1097/ccm.0b013e318170aa97
34.
Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M. Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet. 2002;360:219-23.
Not in our library10.1016/s0140-6736(02)09459-x
35.
Hermans G, Casaer MP, Clerckx B, Guiza F, Vanhullebusch T, Derde S, Meersseman P, Derese I, Mesotten D, Wouters P, et al. Effect of tolerating macronutrient deficit on the development of intensive-care unit acquired weakness: a subanalysis of the EPaNIC trial. Lancet Respir Med. 2013;1:621-9.
Not in our library10.1016/s2213-2600(13)70183-8
36.
Masiero E, Agatea L, Mammucari C, Blaauw B, Loro E, Komatsu M, Metzger D, Reggiani C, Schiaffino S, Sandri M. Autophagy is required to maintain muscle mass. Cell Metab. 2009;10:507-15.
Not in our library10.1016/j.cmet.2009.10.008
37.
Zochodne DW, Bolton CF, Wells GA, Gilbert JJ, Hahn AF, Brown JD, Sibbald WA. Critical illness polyneuropathy. A complication of sepsis and multiple organ failure. Brain. 1987;110(Pt 4):819-41.
Not in our library10.1093/brain/110.4.819
38.
Witt NJ, Zochodne DW, Bolton CF, Grand'Maison F, Wells G, Young GB, Sibbald WJ. Peripheral nerve function in sepsis and multiple organ failure. Chest. 1991;99:176-84.
Not in our library10.1378/chest.99.1.176
39.
Garnacho-Montero J, Madrazo-Osuna J, Garcia-Garmendia JL, Ortiz-Leyba C, Jimenez-Jimenez FJ, Barrero-Almodovar A, Garnacho-Montero MC, Moyano-Del-Estad MR. Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med. 2001;27:1288-96.
Not in our library10.1007/s001340101009
40.
Bednarik J, Vondracek P, Dusek L, Moravcova E, Cundrle I. Risk factors for critical illness polyneuromyopathy. J Neurol. 2005;252:343-51.
Not in our library10.1007/s00415-005-0654-x

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