title: Acquired Muscle Weakness in the Surgical Intensive Care Unit: Nosology, Epidemiology, Diagnosis, and Prevention.
abstract: Muscle weakness is common in the surgical intensive care unit (ICU). Low muscle mass at ICU admission is a significant predictor of adverse outcomes. The consequences of ICU-acquired muscle weakness depend on the underlying mechanism. Temporary drug-induced weakness when properly managed may not affect outcome. Severe perioperative acquired weakness that is associated with adverse outcomes (prolonged mechanical ventilation, increases in ICU length of stay, and mortality) occurs with persistent (time frame: days) activation of protein degradation pathways, decreases in the drive to the skeletal muscle, and impaired muscular homeostasis. ICU-acquired muscle weakness can be prevented by early treatment of the underlying disease, goal-directed therapy, restrictive use of immobilizing medications, optimal nutrition, activating ventilatory modes, early rehabilitation, and preventive drug therapy. In this article, the authors review the nosology, epidemiology, diagnosis, and prevention of ICU-acquired weakness in surgical ICU patients.
authors.affiliation: From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (H.F., I.M.-D., M.E.); Department of Anesthesia and Critical Care Medicine, Section of Neuroanesthesia and Neurocritical Care, University of Brescia at Spedali Civili, Brescia, Italy (N.L.); Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, Massachusetts (R.Z.); and Klinik für Anästhesiologie und Intensivmedizin, Universitaetsklinikum Essen, Essen, Germany (M.E.).
authors.forename: Hassan
authors.initials: H
authors.lastname: Farhan
authors.forename: Ingrid
authors.initials: I
authors.lastname: Moreno-Duarte
authors.forename: Nicola
authors.initials: N
authors.lastname: Latronico
authors.forename: Ross
authors.initials: R
authors.lastname: Zafonte
authors.forename: Matthias
authors.initials: M
authors.lastname: Eikermann
mesh_terms: D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006801:Humans; D007049:Iatrogenic Disease; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D018908:Muscle Weakness / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000706:statistics & numerical data