1. Singh Joy, Subhashni D.


According to this study:


* Early physical and occupational therapy may decrease weakness during ICU stays.



Article Content

Patients in ICUs commonly develop weakness as a complication of illness. This topic was the focus of discussion at the 2009 Brussels Round Table Conference, the deliberations of which are summarized in an article by Griffiths and Hall.


While electrophysiologic screening may determine critical illness polyneuropathy and/or critical illness myopathy, there are limitations to this method. Instead, many support using a more general approach to identifying ICU-acquired weakness (ICU-AW), such as a neuromuscular exam during sedative interruption. Although incidence of ICU-AW tends to vary depending on the tool used to define it, ICU-AW is common, and reducing its occurrence should be a goal of patient care.


A number of risk factors for ICU-AW were identified and include medications (such as corticosteroids and neuromuscular blocking agents), immobility, and sepsis. Loss of mechanical loading of muscles and prolonged ventilation were also found to be associated with weakness. Addressing these risk factors may help prevent ICU-AW.


The authors recommend attempting to achieve glycemic control in critically ill patients; however, the exact target range for blood glucose levels was not determined. Nutritional supplements and early nutrition may help to halt the loss of muscle mass, but this remains an area of debate. Improved status and outcomes in critically ill patients have also been seen with early physical and occupational therapy combined with breaks from sedative medications. Limiting the use of sedatives and analgesia during mechanical ventilation may help reduce bed rest and possibly the development of ICU-AW.


Griffiths RD, Hall JB. Crit Care Med 2010;38(3):1-9.