Clinically detected weakness in critically ill patients in whom there is no plausible aetiology other than critical illness. Incidence is about 40-50% in patients who develop MOF, severe sepsis and require prolonged ventilation. Hyperglycaemia is an additional risk factor. Steroids, aminoglycosides, NMBD… are all suggested as potential risk factors.
- Critical Illness Polyneuropathy (CIP)
- Critical Illness Myopathy (CIM) – this is further classified histologically:
- Cachectic Myopathy
- Thick Filament Myopathy
- Necrotizing Myopathy
- Critical Illness Neuromyopathy (CINM)
- Weakness following critical illness
- Generalized, symmetrical, flaccid weakness, with cranial nerve spearing
- Causes not related to underlying critical illness
- Mean muscle power <4/5 in all testable muscle groups, on >2 occasions separated by >24 h
- Ventilator dependence
- Hypothesised to be a “peripheral neuromuscular failure” due to the inflammatory cytokines, and poor macro & microvascular perfusion implicated in other organ failures.
- Atrophy and denervation due to lack of use
From the NEJM Critical Care review series: ICU-Acquired Weakness and Recovery from Critical Illness. N Engl J Med 2014; 370:1626-1635
Intensive care unit-acquired weakness, Appletin & Kinsella, CEACCP 2012