A stronger approach to weakness in the intensive care unit.
ICU-acquired limb and respiratory muscle weakness is a common, serious ICU syndrome, increasing in frequency with prolonged ICU stay and sepsis. A systematic approach facilitates precise localization of the problem within central or peripheral nervous system. Most cases relate to critical illness polyneuropathy or myopathy or a combination of both (critical illness neuromyopathy). Within the latter entity, the relative contribution of neuropathy versus myopathy varies considerably among affected patients. Muscle enzyme testing, electromyography-nerve conduction and muscle biopsy are valuable investigative tests. Nerve biopsy is less commonly needed, but is useful when vascultis is suspected.
Young
G Bryan
GB
Department of Clinical Neurological Sciences, The University of Western Ontario, London, Ontario, Canada. bryan.young@lhsc.on.ca
Hammond
Robert R
RR
D016638:Critical Illness; D004576:Electromyography; D006801:Humans; D007049:Iatrogenic Disease; D007362:Intensive Care Units; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000209:etiology; D009133:Muscular Atrophy / Q000150:complications / Q000175:diagnosis*; D016878:POEMS Syndrome / Q000175:diagnosis* / Q000209:etiology; D015300:Ventilator Weaning