Delerium

Resources

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From the NEJM Critical Care review series: Sedation and Delirium in the Intensive Care Unit. N Engl J Med 2014; 370:444-454

 Delirium in the Critically Ill. Intensive Care Society (2006)

CAM-ICU worksheet

ICU Delerium study group

Sedation

Resources

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From the NEJM Critical Care review series: Sedation and Delirium in the Intensive Care Unit. N Engl J Med 2014; 370:444-454

ICU-Acquired Weakness

Definition

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.

 

Classification

• Critical Illness Polyneuropathy (CIP)
• Critical Illness Myopathy (CIM) – this is further classified histologically:
  • Cachectic Myopathy
  • Thick Filament Myopathy
  • Necrotizing Myopathy
• Critical Illness Neuromyopathy (CINM)

 

Criteria

All of:

• Weakness following critical illness
• Generalized, symmetrical, flaccid weakness, with cranial nerve spearing
• Causes not related to underlying critical illness

And either:

• Mean muscle power <4/5 in all testable muscle groups, on >2 occasions separated by >24 h
• Ventilator dependence

 

Pathology

• 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

 

Resources

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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