INTENSIVE CARE UNIT–ACQUIRED
WEAKNESS
As survival after critical illness has improved over the
years, many patients now require on-going rehabilitation
after discharge from the ICU. Profound neuromuscular
weakness, or ICU-AW, is common and leads to severe
functional impairment in many ICU survivors. Risk factors
for ICU-AW are multifactorial and can include disease
severity, presence of systemic inflammatory response syndrome
(SIRS),161 number of days with two or more organ
dysfunctions, duration of mechanical ventilation,162 ICU
LOS, serum glucose levels,163 and use of corticosteroids
or NMBAs.164 Controversies exist over the risks and benefits
of tight glycemic control, and a causal relationship
between the use of corticosteroids or NMBAs has not
been clearly established. At present, few options are available
to prevent or treat ICU-AW specifically.165
A potential therapeutic option is the avoidance of
bed rest with early mobilization in the ICU. Exercise
can improve strength and increase the production of
antiinflammatory cytokines, which may play an important
role in muscle protection.166 Griffiths and coworkers
described the effects of continuous passive motion of one
leg in patients with respiratory failure receiving NMBAs.
The contralateral leg served as the control. Muscle DNAto-
protein ratio (an index of wasting) was significantly
less reduced in the leg receiving passive motion