6.16 ICU Acquired Weakness Flashcards
a) What are the main types of intensive care unit (ICU)-acquired
weakness?
● Critical illness polyneuropathy.
● Critical illness myopathy.
● Critical illness neuromyopathy.
b) What are the risk factors for ICU-acquired weakness?
● Severe sepsis.
● Multi-organ failure.
● Prolonged mechanical ventilation.
● Long duration of SIRS.
● Hyperglycaemia.
● Female sex and old age.
● Malnutrition.
● Large cumulative dose of steroids.
● Prolonged neuromuscular blockade.
● Aminoglycosides.
● Renal replacement therapy.
c) What are the main postulated mechanisms in the development of ICU-acquired weakness?
● Reduced oxygen delivery to the nerve axons.
● Mitochondrial dysfunction.
● Reduced nutrient delivery to the nerve axons.
● Altered membrane (sodium) channel function.
● Altered sarcoplasmic reticulum function
in the release and uptake of calcium.
● Axonal damage from neurotoxins.
● Oxidative stress and damage secondary to hyperglycaemia
● Muscle atrophy.
● Muscle denervation.
d) What are the main clinical features essential for diagnosing
ICU-acquired weakness?
● Weakness developing after an onset of critical illness.
● Generalised, symmetrical, flaccid weakness
sparing cranial nerves.
● Cause of weakness not related
to the underlying critical illness.
● Muscle power score fitting the criteria
set by the Medical Research Council (MRC).
● Dependence on mechanical ventilation.
e) What are the main complications associated with ICU-acquired weakness?
● Prolonged mechanical ventilation.
● The possibility of dangerous hyperkalaemia
with depolarising
neuromuscular blockers.
● Prolonged hospital length of stay.
● Increased morbidity and mortality.
f) What is the mainstay of treatment of ICU-acquired weakness
● Prevention.
● Rehabilitation.
● Physiotherapy.
● Occupational therapy.
● Psychological support.
