Trivia Quiz: What Do You Know About ICU Acquired Weakness?

1. What is a sign or symptom of ICU acquired weakness?

One week intubation

Weight loss

Prolonged bed rest

All of the above

ICU acquired weakness refers to the muscle weakness that occurs in patients who have been in the intensive care unit (ICU) for a prolonged period of time. One week intubation, weight loss, and prolonged bed rest are all signs or symptoms of ICU acquired weakness. Intubation for a week can lead to muscle atrophy and weakness. Weight loss is often seen in ICU patients due to decreased appetite and increased metabolic demands. Prolonged bed rest can result in muscle wasting and loss of strength. Therefore, all of the above options are signs or symptoms of ICU acquired weakness.

Explanation

ICU acquired weakness refers to the muscle weakness that occurs in patients who have been in the intensive care unit (ICU) for a prolonged period of time. One week intubation, weight loss, and prolonged bed rest are all signs or symptoms of ICU acquired weakness. Intubation for a week can lead to muscle atrophy and weakness. Weight loss is often seen in ICU patients due to decreased appetite and increased metabolic demands. Prolonged bed rest can result in muscle wasting and loss of strength. Therefore, all of the above options are signs or symptoms of ICU acquired weakness.

2. What are the 2 main complications of ICU acquired weakness?

Sepsis & mechanical ventilation

Neuropathy & weight loss

Neuropathy & myopathy

Sepsis & myopathy

All options are associated with ICU acquired weakness, but neuropathy and myopathy are the main complications.

Explanation

All options are associated with ICU acquired weakness, but neuropathy and myopathy are the main complications.

3. When is it important to investigate which type of ICU acquired weakness (polyneuropathy or myopathy) is present?

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

When recovery is slower than expected for ICU acquired weakness, it is important to investigate which type of weakness (polyneuropathy or myopathy) is present. This is because different treatment approaches may be required depending on the underlying cause of the weakness. By identifying the specific type of weakness, healthcare professionals can tailor the treatment plan accordingly, potentially leading to more effective and targeted interventions for the patient's recovery.

Explanation

When recovery is slower than expected for ICU acquired weakness, it is important to investigate which type of weakness (polyneuropathy or myopathy) is present. This is because different treatment approaches may be required depending on the underlying cause of the weakness. By identifying the specific type of weakness, healthcare professionals can tailor the treatment plan accordingly, potentially leading to more effective and targeted interventions for the patient's recovery.

4. Considering the information presented in the literature, which of the following is most frequently suggested in regards to areas of further research:

The effectiveness and quality of the interventions for CINM

The mechanisms by which CINM causes dysfunction

Treatment of CINM with NMES and cycle ergometry

The correct answer suggests that further research is needed in the area of treatment for CINM. Specifically, larger, long term, multicentre clinical trials are required to gather more evidence on the effectiveness of CINM treatment and ICU mobilization as a whole. This implies that there is still uncertainty regarding the efficacy of current treatments for CINM and the benefits of mobilizing patients in the ICU.

Explanation

The correct answer suggests that further research is needed in the area of treatment for CINM. Specifically, larger, long term, multicentre clinical trials are required to gather more evidence on the effectiveness of CINM treatment and ICU mobilization as a whole. This implies that there is still uncertainty regarding the efficacy of current treatments for CINM and the benefits of mobilizing patients in the ICU.

5. Mr. Y was admitted to ICU 2/7 ago following a motor vehicle accident. He is sedated, physiologically and hemodynamically stable. He has been administered a neuromuscular block in conjunction with mechanical ventilation. Which intervention strategy would you recommend for Mr. Y at this point in time?

Electromuscular stimulation

Passive bedside cycle ergometry with passive stretching

Patient is not ready for intervention at this point

Interferential current therapy

Passive bedside cycle ergometry with passive stretching would be the recommended intervention strategy for Mr. Y at this point in time. This intervention involves using a stationary cycle machine to move the patient's limbs in a controlled manner, promoting circulation and preventing muscle atrophy. Passive stretching is also incorporated to maintain or improve joint range of motion. This intervention is suitable for Mr. Y as he is sedated and physiologically stable, allowing for gentle movement without causing harm or discomfort.

Explanation

Passive bedside cycle ergometry with passive stretching would be the recommended intervention strategy for Mr. Y at this point in time. This intervention involves using a stationary cycle machine to move the patient's limbs in a controlled manner, promoting circulation and preventing muscle atrophy. Passive stretching is also incorporated to maintain or improve joint range of motion. This intervention is suitable for Mr. Y as he is sedated and physiologically stable, allowing for gentle movement without causing harm or discomfort.

6. Which of the following has not been demonstrated as an effect of electromuscular stimulation?

Increased microcirculation of thenar muscles

Improved oxidative capacity of muscles

Stimulation of anabolic pathways

Inhibition of Aβ pathways, inhibiting pain

Electromuscular stimulation has been shown to have various effects on muscles, such as increased microcirculation, improved oxidative capacity, and stimulation of anabolic pathways. However, there is no evidence to suggest that it inhibits Aβ pathways, which are associated with pain. Therefore, the correct answer is "Inhibition of Aβ pathways, inhibiting pain."

Explanation

Electromuscular stimulation has been shown to have various effects on muscles, such as increased microcirculation, improved oxidative capacity, and stimulation of anabolic pathways. However, there is no evidence to suggest that it inhibits Aβ pathways, which are associated with pain. Therefore, the correct answer is "Inhibition of Aβ pathways, inhibiting pain."

7. When would clinicians NOT be likely to suspect ICU-Acquired Weakness?

Musculoskeletal patients experience abnormally slow recovery post orthopaedic surgery

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

Clinicians would not be likely to suspect ICU-Acquired Weakness in musculoskeletal patients experiencing abnormally slow recovery post orthopaedic surgery because this is a common occurrence in these patients. The slow recovery is expected due to the nature of the surgery and the trauma to the musculoskeletal system. ICU-Acquired Weakness is typically characterized by weakness in patients who should be recovering normally, such as neurology patients who experience cognitive and sensory recovery but still appear quadriplegic, or patients who show respiratory muscle weakness despite normal global recovery. Therefore, the slow recovery in musculoskeletal patients is not indicative of ICU-Acquired Weakness.

Explanation

Clinicians would not be likely to suspect ICU-Acquired Weakness in musculoskeletal patients experiencing abnormally slow recovery post orthopaedic surgery because this is a common occurrence in these patients. The slow recovery is expected due to the nature of the surgery and the trauma to the musculoskeletal system. ICU-Acquired Weakness is typically characterized by weakness in patients who should be recovering normally, such as neurology patients who experience cognitive and sensory recovery but still appear quadriplegic, or patients who show respiratory muscle weakness despite normal global recovery. Therefore, the slow recovery in musculoskeletal patients is not indicative of ICU-Acquired Weakness.

8. Which of the following does not contribute to weakness in the ICU?

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

Alterations in baroreceptor function contributes to postural hypotension and tachycardia, but not directly to skeletal muscle weakness.

Explanation

Alterations in baroreceptor function contributes to postural hypotension and tachycardia, but not directly to skeletal muscle weakness.

9. After spending one week in the ICU, how much muscle strength would you expect Mr. Y to have lost?

1.5%

3%

4%

7%

After spending one week in the ICU, it is expected that Mr. Y would have lost approximately 4% of his muscle strength. This can be attributed to the prolonged period of immobility and lack of physical activity during his stay in the intensive care unit. Lack of movement and muscle use can lead to muscle atrophy and weakness. Therefore, it is reasonable to assume that Mr. Y would experience a loss of muscle strength of around 4% after spending one week in the ICU.

Explanation

After spending one week in the ICU, it is expected that Mr. Y would have lost approximately 4% of his muscle strength. This can be attributed to the prolonged period of immobility and lack of physical activity during his stay in the intensive care unit. Lack of movement and muscle use can lead to muscle atrophy and weakness. Therefore, it is reasonable to assume that Mr. Y would experience a loss of muscle strength of around 4% after spending one week in the ICU.

10. Which of the following was not identified by de Jonghe, B., et al 2009 as an obstacle to further research:

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

The correct answer is that the mortality rate in patients that require 5-7 days of ventilation is high. This is identified as an obstacle to further research because it makes it challenging to assess for ICUAW before the patient's condition deteriorates.

Explanation

The correct answer is that the mortality rate in patients that require 5-7 days of ventilation is high. This is identified as an obstacle to further research because it makes it challenging to assess for ICUAW before the patient's condition deteriorates.