Overview
Critical illness neuromyopathy encompasses ICU-acquired weakness, primarily manifesting as critical illness polyneuropathy or myopathy, affecting limb and respiratory muscles, often exacerbated by prolonged ICU stays and sepsis 23.Diagnosis
Clinical Presentation: Weakness in limb and respiratory muscles 23.
Investigative Tests:
- Muscle enzyme testing
- Electromyography and nerve conduction studies
- Muscle biopsy (necessity varies; nerve biopsy if vasculitis suspected) 3
Differentiation: Distinguish between central and peripheral nervous system involvement through systematic assessment 3Management
Preventive Measures:
- Optimize glycemic control (strict vs. conventional) 2
- Minimize corticosteroid use where possible 2
- Limit use of neuromuscular blockers 2
- Promote early mobilization and physical therapy 2
Supportive Care: Mechanical ventilation support and rehabilitation programs 2Special Populations
Pregnancy: Women neurologists in training face unique challenges balancing family responsibilities with prolonged training due to potential delays from childbearing 1
Elderly: Not specifically addressed in provided abstracts
Comorbidities: Multiple organ failure is a significant risk factor 2Key Recommendations
Implement strict glycemic control to potentially reduce the incidence of critical illness neuromyopathy (Evidence: Moderate) 2
Minimize the use of corticosteroids and neuromuscular blockers to mitigate risk factors for neuromyopathy (Evidence: Moderate) 2
Encourage early mobilization and physical therapy to prevent ICU-acquired weakness (Evidence: Moderate) 2References
1 Rouse S, Raedy A, Khan F. Challenges Training Women in Neurology. Neurologic clinics 2023. link
2 de Jonghe B, Lacherade JC, Sharshar T, Outin H. Intensive care unit-acquired weakness: risk factors and prevention. Critical care medicine 2009. link
3 Young GB, Hammond RR. A stronger approach to weakness in the intensive care unit. Critical care (London, England) 2004. link