ICU-Acquired Weakness (CIP/CIM)

ICU-acquired weakness (ICUAW) is the acquired muscle and nerve dysfunction that develops during critical illness, affecting 25 to 50 percent of ICU patients ventilated over 7 days. Three types: critical illness polyneuropathy (CIP), critical illness myopathy (CIM), critical illness neuromyopathy (CINM). Risk factors: sepsis/MODS, prolonged ventilation, steroids, NMBA, hyperglycaemia, immobility. Prevention: ABCDEF bundle, early mobilisation, glycaemic control, minimise sedation/NMBA/steroids. Treatment: supportive, rehabilitation, nutrition. Long-term disability persists for years after ICU discharge.

high6 referencesUpdated 26 July 20267 min readVerification in progress

Practise this topic

8 MCQs

Meet the patient

Day 9 of a pneumococcal ARDS run: the fevers have settled, the sedation has been weaned, and the team wants to extubate. The 62-year-old in bed 7 opens her eyes, grips your hand feebly, and cannot lift either limb off the mattress — yet she grimaces, blinks and nods to command, and her facial strength is normal. She has just failed her second spontaneous breathing trial despite a clear chest film.^[1]

The pattern is the giveaway: symmetric limb weakness with spared cranial nerves after a week of sepsis, steroids and immobility. Hold the two questions the rest of the admission turns on — why did this happen (name the risk factors) and how do I stop it deepening (the prevention bundle).^[1]

References6Show

[1]Latronico N, Bolton CF Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis Lancet Neurol, 2011.PMID 21939902
[2]Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G Clinical review: Critical illness polyneuropathy and myopathy Crit Care, 2008.PMID 19040777
[3]Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial Lancet, 2009.PMID 19446324
[4]Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness JAMA, 2013.PMID 24108501
[5]Herridge MS, Tansey CM, Matté A, et al. Functional disability 5 years after acute respiratory distress syndrome N Engl J Med, 2011.PMID 21470008
[6]Nordon-Craft A, Moss M, Quan D, Schenkman M Intensive care unit-acquired weakness: implications for physical therapist management Phys Ther, 2012.PMID 22282769

ICU-Acquired Weakness (CIP/CIM)

high6 referencesUpdated 26 July 20267 min readVerification in progress

Practise this topic

8 MCQs

Meet the patient

References6Show

[1]Latronico N, Bolton CF Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis Lancet Neurol, 2011.PMID 21939902
[2]Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G Clinical review: Critical illness polyneuropathy and myopathy Crit Care, 2008.PMID 19040777
[3]Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial Lancet, 2009.PMID 19446324
[4]Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness JAMA, 2013.PMID 24108501
[5]Herridge MS, Tansey CM, Matté A, et al. Functional disability 5 years after acute respiratory distress syndrome N Engl J Med, 2011.PMID 21470008
[6]Nordon-Craft A, Moss M, Quan D, Schenkman M Intensive care unit-acquired weakness: implications for physical therapist management Phys Ther, 2012.PMID 22282769