title: Myopathic characteristics in septic mechanically ventilated patients.
abstract: OBJECTIVE
  Survivors of a critical illness may experience poor physical function and quality of life as a result of reduced skeletal muscle mass and strength during their acute illness. Patients diagnosed with sepsis are particularly at risk, and mechanical ventilation may result in diaphragm dysfunction. Interest in the interaction of these conditions is both growing and important to understand for individualized patient care.
  
  
  RESULTS
  This review describes developments in the presentation of both diaphragm and limb myopathy in critical illness, as measured from muscle biopsy and at the bedside with various imaging and strength-testing modalities. The influence of unloading of the diaphragm with mechanical ventilation and peripheral muscles with immobilization in septic patients has been recently questioned. Systemic inflammation appears to primarily accelerate and accentuate dysfunction, which may be remedied by early mobilization and augmented with developing muscle and/or nerve stimulation techniques.
  
  
  CONCLUSIONS
  Many acute muscle changes in septic patients are likely to stem from pre-existing impairments, which should provide context for clinical evaluations of strength. During illness, sarcolemmal injury promotes a cascade of intra-cellular abnormalities. As unique characteristics of ICU-acquired weakness and differential effects on muscle groups are understood, early diagnosis and management should be facilitated.
authors.affiliation: aInternational Centre for Allied Health Evidence and School of Health Sciences, University of South Australia, Adelaide bPhysiotherapy Department, Flinders Medical Centre, Bedford Park cDepartment of Critical Care Medicine, School of Medicine, Faculty of Health Sciences, Flinders University, Bedford Park dIntensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Baldwin
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Bersten
mesh_terms: D001510:Bed Rest / Q000009:adverse effects*; D003422:Critical Care; D016638:Critical Illness; D003964:Diaphragm; D006801:Humans; D007249:Inflammation / Q000209:etiology; D018908:Muscle Weakness / Q000209:etiology*; D018482:Muscle, Skeletal; D009135:Muscular Diseases; D012121:Respiration, Artificial / Q000009:adverse effects*; D018805:Sepsis / Q000150:complications / Q000628:therapy*