Intensive care unit acquired weakness. Pathogenesis, treatment, rehabilitation and outcome

• Published in: Nervenarzt 2014-02, Vol.85 (2), p.195
• Main Authors: Ponfick, M, Bösl, K, Lüdemann-Podubecka, J, Neumann, G, Pohl, M, Nowak, D A, Gdynia, H-J
• Format: Article
• Language: ger
• Subjects: Bed Rest - adverse effects; Critical Care; Early Ambulation - methods; Evidence-Based Medicine; Humans; Muscle Weakness - diagnosis; Muscle Weakness - etiology; Muscle Weakness - rehabilitation; Respiration, Artificial - adverse effects
• ISSN: 1433-0407
• DOI: 10.1007/s00115-013-3958-6

The diagnosis of intensive care unit acquired weakness (ICUAW) in the setting of neurological rehabilitation is steadily increasing. This is due to the fact that the intensive care of patients with sepsis or after cardiac or abdominal surgery is improving. A longer duration of respiratory weaning and comorbidities frequently complicate rehabilitation. Clinically, patients present with a flaccid (tetra) paresis and electrophysiological studies have shown axonal damage. Besides involvement of peripheral nerves, muscle can also be affected (critical illness myopathy) leading to ICUAW with inconstant myopathic damage patterns found by electrophysiological testing. Mixed forms can also be found. A specific therapy for ICUAW is not available. Early mobilization to be initiated on the intensive care unit and commencing neurological rehabilitation improve the outcome of ICUAW. This review highlights the current literature regarding the etiology and diagnosis of ICUAW. Furthermore, studies about rehabilitation and outcome of ICUAW are discussed.