What do you know about ICU acquired weakness? This is a test of your knowledge of the disease process, clinical presentation, physiotherapy management, and future direction of ICU acquired weakness. Give it a try and get to review how well you take care of those patients suffering from it and the signs associated with it. All the best!
Sepsis & mechanical ventilation
Neuropathy & weight loss
Neuropathy & myopathy
Sepsis & myopathy
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While the patient is still sedated
When recovery is faster than expected for ICU acquired weakness
Every time ICU acquired weakness is diagnosed
When recovery is slower than expected for ICU acquired weakness
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The effectiveness and quality of the interventions for CINM
The mechanisms by which CINM causes dysfunction
Treatment of CINM is an emerging area. Thus larger, long term, multicentre clinical trials are required to gain more evidence into the efficacy of CINM treatment and ICU mobilization as a whole
Treatment of CINM with NMES and cycle ergometry
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Electromuscular stimulation
Passive bedside cycle ergometry with passive stretching
Patient is not ready for intervention at this point
Interferential current therapy
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Increased microcirculation of thenar muscles
Improved oxidative capacity of muscles
Stimulation of anabolic pathways
Inhibition of Aβ pathways, inhibiting pain
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Musculoskeletal patients experience abnormally slow recovery post orthopaedic surgery
Neurology patients in the ICU experience a recovery of cognitive, memory, sensory function, yet are so weak as to appear quadriplegic
While weaning patients off ventilation, clinicians notice respiratory muscle weakness (hindering return to spontaneous breathing) despite normal global recovery
When symmetrical global motor deficiencies are present, but facial muscles are impaired
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Disruption of muscle synthesis and proteolysis
Alterations in baroreceptor function
Change of type I slow twitch fibres to type II fast twitch fibres
Increased proinflammatory cytokines and inflammatory state
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1.5%
3%
4%
7%
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There is a lack of commonly accepted diagnostic criteria for CINM
Despite electrophysiology being a reliable method of detecting CINM, the clinical relevance of the abnormalities it detects remains unknown
ICUAW occurs predominately in patients who require at least 5-7 days of mechanical ventilation. However, as the length of ventilation time cannot be predicted prior to treatment, many patients will be randomized for a trial despite only being at a low risk for developing CINM
The mortality rate in patients that require 5-7 day of ventilation is high. Thus, assessment for ICUAW is challenging as it needs to be completed before their condition deteriorates
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