ICU · Rehabilitation

ICU-acquired weakness (critical illness myopathy/polyneuropathy)

Also known as ICU-acquired weakness (ICUAW) · Critical illness myopathy (CIM) · Critical illness polyneuropathy (CIP) · Critical illness neuromyopathy (CINM) · Sarcopenia in ICU

ICU-acquired weakness (ICUAW) occurs in about a quarter of patients ventilated 7 days or longer (25.3% in the landmark cohort) and roughly half of critically ill adults overall. Comprises critical illness myopathy (CIM — muscle), critical illness polyneuropathy (CIP — peripheral nerves), or both (CINM). Risk factors: sepsis and multi-organ failure, prolonged mechanical ventilation, hyperglycaemia, immobilisation, corticosteroids, neuromuscular blocking agents. Diagnosis: clinical (MRC sum score <48/60), confirmed by electrophysiology (nerve conduction studies, EMG) and sometimes muscle biopsy. Prevention: glycaemic control (intensive insulin cut critical illness polyneuropathy by 44% in Leuven, but the tight 4.5-6.0 mmol/L target increased 90-day mortality in NICE-SUGAR — treat hyperglycaemia, do not over-tighten), minimise sedation (daily sedation interruption), early mobilisation within 72 h of starting ventilation, minimise steroids/NMBAs, avoid under- and over-feeding. Outcomes: prolonged weaning, more ventilator days, worse mortality, and muscle weakness as the dominant complaint at one year.