4 (c) Rehab in ICU

Question 1

Bedrest in ICU

Answer 1

• Prolonged bed rest
–dec muscle protein synthesis
– dec muscle catabolism
– dec muscle mass, especially in the lower extremities
• Short‐term immobility may impair microvascular
function and induce insulin resistance, which
potentiates injuries to muscle and nerves in the
critically ill.
•inc proinflammatory cytokines cause further muscle
damage and loss.

• Prolonged physical inactivity can result in generalized
pain and changes in mood, which may limit physical
function

Question 2

BGL of ICU patients

Answer 2

– Hyperglycaemia

Question 3

Critical illness myopathy//neuromyopathy/polyneuropathy

Answer 3

The subsets of these patients with ICU‐ acquired
weakness who have electro‐ physiologically
documented axonal polyneuropathy have “critical
illness polyneuropathy” (CIP), and those with
documented myopathy have “critical illness
myopathy.” (CIM)
• CIP first identified in 1984
• Most commonly, CIP and CIM occur together and are
designated “critical illness neuromyopathy” CINM

Generalized weakness developing after the onset of
critical illness
• Weakness is diffuse (involving both proximal and
distal muscles), symmetric, flaccid, and generally
spares cranial nerves
• Causes of weakness not related to the underlying
critical illness have been excluded
• Other causes of weakness eg GBS are also excluded

Question 4

Trends in mangement of critical illness to avoid myopathy/neuropathy

Answer 4

• Decrease sedation
• ? Avoid corticosteroids & NMBA
• Insulin therapy to avoid hyper/hypoglycaemia
• Adequate nutrition
• Early mobilisation