critical illness weakness; critical illness neuromyopathy
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Introduction
Critically ill patients with multiorgan system failure may develop severe muscle weakness associated with respiratory failure.
Classification
distinct syndromes
- critical illness polyneuropathy
- critical illness myopathy
- vencuronium-induced prolonged neuromuscular blockade
Etiology
- prolonged (> 7 day) stay in ICU
- administration of pharmaceutical agents may contribute
- other factors
- sepsis
- malnutrition
- muscle catabolism
- disuse
- hyperglycemia
- systemic inflammatory response syndrome
- multiple organ dysfunction
Clinical manifestations
- if critical illness is prolonged, weakness may progress out of proportion to deconditioning expected from immobility
- inability to extubate
- flaccid predominantly proximal muscle weakness
- areflexia may be present
- not associated with cognitive impairment
Laboratory
- serum creatine kinase elevated
- plasma glucose may be elevated
Diagnostic procedures
- Medical Research Council muscle scale 1st step in evalutating critical illness weakness[1] (rarely used[1])
- electromyoagraphy (EMG)
- absent or dimininished sensory responses
- low-amplitude motor units
Complications
- inability to wean patient from mechanical ventilation
- prolonged post-hospital muscle weakness
Management
- respiratory support
- appropriate glycemic control; wean off glucocorticoids[1]
- early moblization & therapy
- prognosis
- vencuronium-induced neuromuscular blockade improves rapidly when agent is stopped
- recovery from other syndromes may take weeks to months or may persist indefinitely
More general terms
More specific terms
Additional terms
- critical illness neuropsychiatric impairment (post-ICU neuropsychiatric impairment)
- ICU-acquired weakness
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Griffiths RD, Hall JB. Intensive care unit-acquired weakness. Crit Care Med. 2010 Mar;38(3):779-87. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20048676
- ↑ Wieske L, Harmsen RE, Schultz MJ, Horn J. Is critical illness neuromyopathy and duration of mechanical ventilation decreased by strict glucose control? Neurocrit Care. 2011 Jun;14(3):475-81 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21267673
- ↑ Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014 Jul 17;371(3):287-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25014703