Intensive Care Unit Acquired Weakness (ICU-AW): a brief and practical review

Abstract

Intensive care unit-acquired weakness (ICU-AW) is an increasingly complication of survivors of critical illness. It should be suspected in the presence of  a patient with a flaccid  tetraparesis or tetraplegia with hyporeflexia or absent deep tendon reflexes and difficult to weaning from mechanical ventilation in the absence of different diagnoses. Important risk factors are age, sepsis, illness duration and severity, some drugs (neuromuscular blockers, steroids). Electrophysiological studies have shown an axonal damage of involved peripheral nerves (critical illness polyneuropathy). However, muscle can also be primitively affected (critical illness myopathy) leading to ICUAW with inconstant myopathic damage patterns in electromyographic studies. Mixed forms can are present (critical illness polyneuromyopathy. Although the pathophysiology remains obscure, the hypothesis of an acquired channelopathy is substantial.Electroneuromyography is crucial for diagnosis. Muscular and nerve biopsy are necessary for diagnosis confirmation. Aggressive treatment of baseline disease, prevention, through avoiding or minimizing precipitating factors, strict glycemic control, and early rehabilitation combining mobilization with physiotherapy and muscle electrical muscle stimulation, are the keys to improving recovery of the affected individuals. This narrative review highlights the current literature regarding the etiology and diagnosis of ICU-AW.