Intensive Care Unit-Acquired Weakness
Authors:
Jiroutková Kateřina 1; Duška František 2,3
Authors‘ workplace:
Klinika anesteziologie a resuscitace, Kardiocentrum, Institut klinické a experimentální medicíny, Praha
1; Klinika anesteziologie a resuscitace 3. LF UK a Fakultní nemocnice Královské Vinohrady
2; Oddělení biochemie a molekulární biologie 3. LF UK, Praha
3
Published in:
Anest. intenziv. Med., 22, 2011, č. 3, s. 163-168
Category:
Intensive Care Medicine - Review Article
Overview
Intensive Care Unit-Acquired Weakness (ICUAW) is a common complication of intensive care that places significant impact on the long-term outcome. ICUAW is associated with systemic inflammatory response syndrome (SIRS) and is now considered an aspect of the multiple-organ failure syndrome at the level of peripheral nerves and muscles. The membrane of the peripheral nerve is hyperpolarized and is inexcitable at least in part due to the changes of both the number and features of the Na+ channels. Within the muscles, the intracellular Ca2+ fluctuation pattern flattens during the cycle of contraction-relaxation. There is also a decrease in the contractile protein content, and in the reduction of the number of both the nuclei and mitochondria. Thus, the muscle involvement in ICUAW includes both functional changes (myopathy) and a net loss of muscle tissue (sarcopenia). The diagnosis of ICUAW is difficult and often delayed. Direct assessment of the extent to which the muscles and nerves contribute to weakness is often not worthy, as no specific therapy is yet available. The prevention and management of ICUAW now consist of avoiding risk factors, providing adequate nutrition and encouraging the culture of early mobilization of ICU patients.
Keywords:
muscle weakness – critically ill – SIRS – polyneuromyopathy – sarcopenia
Sources
1. Martin, C. M., Hill, A. D., Burns, K., Chen, L. M. Characteristics and outtcomes for critically ill patients with prolonged intensive care unit stays. Crit. Care Med., 2005, 33, p. 1922–1927.
2. Kaplan, V. et al. Pneumonia: Still old mens friend? Arch. Intern. Med., 2003, 163, p. 317–323.
3. Erbsloh, F. Polyneuritic pathological conditions in internal medicine. Munch. Med. Wochenschr. 1955, 97, p. 753–756.
4. Henderson, B., Koepke, G. H., Feller, I. Peripheral polyneuropathy among patiens with burns. Arch. Phys. Med. Rehabil., 1971, 52, p. 149–151.
5. Bischoff, A., Meier, C., Roth, F. Gentamicin neurotoxicity (polyneuropathy – encephalopathy). Schweiz Med. Wochenschr., 1977, 107, p. 3–8.
6. Bolton, C. F., Laverty, D. A., Brown, J. D., Witt, N. J., Hahn, A. F., Sibbald, W. J. Critically ill polyneuropathy. Electrophysiological studies and differentiation from Guillan-Barré syndrome. J. Neurol. Neurosurg. Psychiatry, 1986, 49, p. 563–573.
7. Bolton, C. F., Young, G. B. Sepsis and septic shock: central and peripheral nervous systems. In Sibbald, W. J., Sprung, C. L. (editors) New horizons: perspectives on sepsis and septic shock. Fullerton: Society of Critical Care Medicine, 1986, p. 157–171.
8. Ramsay, D. A., Zochodne, D. W., Robertson, D. M. et al. A syndrome of acute severe muscle necrosis in intensive care unit patients. J. Neuropathol. Exp. Neurol., 1993, 52, p. 387–398.
9. Vincent, J. L., Norrenberg, M. Intensive care unit-acquired weakness: Framing the topic. Crit. Care Med., 2009, Vol. 37, No. 10 (Supp.), p. 296–298.
10. Angel, M. J., Bril, V., Shannon, P., Herridge, M. S. Neuromuscular function in survivors of the acute respiratory distress syndrome. Can. J. Neurol. Sci., 2007, 34, p. 427–432.
11. Stevens, R. D., Dowdy, D. W., Michaels, R. K., Mendez-Tellez, P. A., Pronovost, P. J., Needham, D. M. Neuromuscular dysfunction acquired in critical illness: a systemic review. Intensive Care Med., 2007, 33, p. 1876–1891.
12. Witt, N. J., Zochodne, D. W., Bolton, C. F., Grand’Maison, F., Wells, G., Young, G. B., Sibbald, W. J. Peripheral nerve function in sepsis and multiple organ failure. Chest, 1991, 99, p. 176–184.
13. Bercker, S., Weber-Carstens, S., Deja, M., Grimm, C., Wolf, S., Behse, F., Busch, T., Falke, K. J., Kaisers, U. Critical illness polyneuropathy and myopathy in patients with acute respiratory distress syndrome. Crit. Care Med., 2005, 33, p. 711–715.
14. Tennila, A., Salmi, T., Pettila, V., Roine, R. O., Varpula, T., Takkunen, O. Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med., 2000, 26, p. 1360–1363.
15. De Jonghe, B., Bastuji-Garin, S., Sharshar, T., Outin, H., Brochard, L. Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med., 2004, 30, p. 1117–1121.
16. Garnacho-Montero, J., Amaya-Villar, R., Garcia-Garmendia, J. L., Madrazo-Osuna, J., Ortiz-Leyba, C. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit. Care Med., 2005, 33, p. 349–354.
17. Latronico, N., Fenzi, F., Recupero, D. et al. Critical illness myopathy and neuropathy. Lancet, 1996, 347, p. 1579–1582.
18. Coakley, J. H., Nagendran, K., Yarwood, G. D., Honavar, M., Hinds, C. J. Patterns of neurophysiological abnormality in prolonged critical illness. Intensive Care Med., 1998, 24, p. 801–807.
19. Kleyweg, R. P., van der Meche, F. G., Schmitz, P. I. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillan-Barre syndrome. Muscle Nerve, 1991, 14, p. 1103–1109.
20. Man, W. D., Moxham, J., Polkey, M. I. Magnetic stimulation for the measurement of respiratory and skeletal muscle function. Eur. Respir. J., 2004, 24, p. 846–860.
21. van den Berghe, G., Schoonheydt, K., Becx, P., Bruyninckx, F., Wouters, P. J. Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology, 2005, 64, p. 1348–1353.
22. Bednarik, J., Vondracek, P., Dusek, L., Moravcova, E., Cundrle, I. Risk factors for critical illness polyneuromyopathy. J. Neurol., 2005, 252, p. 343–351.
23. Khan, J., Harrison, T. B., Rich, M. M., Moss, M. Early development of critical illness myopathy and neuropathy in patients with severe sepsis. Neurology, 2006, 67, p. 1421–1425.
24. Latronico, N., Bertolini, G., Guarneri, B., Botteri, M., Peli, E., Andreoletti, S., Bera, P., Luciani, D., Nardella, A., Vittorielli, E., Simini, B., Candiani, A. Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study. Crit. Care, 2007, 11, R11.
25. De Jonghe, B., Sharshar, T., Lefaucheur, J. P., Authier, F. J., Durand-Zaleski, I., Boussarsar, M., Cerf, C., Renaud, E., Mesrati, F., Carlet, J., Raphaël, J. C., Outin, H., Bastuji-Garin, S. Groupe de Réflexion et d’Etude des Neuromyopathies en Réanimation: Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA, 2002, 288, p. 2859–2867.
26. Garnacho-Montero, J., Madrazo-Osuna, J., García-Garmendia, J. L., Ortiz-Leyba, C., Jiménez-Jiménez, F. J., Barrero-Almodóvar, A., Garnacho-Montero, M. C., Moyano-Del-Estad, M. R. Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med., 2001, 27, p. 1288–1296.
27. de Letter, M. A., Schmitz, P. I., Visser, L. H., Verheul, F. A., Schellens, R. L., Op de Coul, D. A., van der Meche, F. G. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit. Care Med., 2001, 29, p. 2281–2286.
28. Campellone, J. V., Lacomis, D., Kramer, D. J., Van Cott, A. C., Giuliani, M. J. Acute myopathy after liver transplantation. Neurology, 1998, p. 46–53.
29. Hermans, G., Wilmer, A., Meersseman, W., Milants, I., Wouters, P. J., Bobbaers, H., Bruyninckx, F., Van den Berghe, G. Impact of intensive insulin therapy on neuromuscular complications and ventilator-dependency in MICU. Am. J. Respir. Crit. Care Med., 2007, 175, p. 480–489.
30. Rich, M. M., Pinter, M. J. Crucial role od sodium channel fast inactivation in muscle fibre inexcitability in a rat model of critical illness myopathy. J. Physiol., 2003, 547, p. 555–566.
31. Massa, R., Carpenter, S., Holland, P., Karpati, G. Loss and renewal of thick myofilaments in glucocorticoid-treated rat soleus after denervation and reinnervation. Muscle Nerve, 1992, 15, p. 1290–1298.
32. Rich, M. M., Bird, S. J., Raps, E. C. et al. Direct muscle stimulation in acute quadriplegic myopathy. Muscle Nerve, 1997, 20, p. 665–673.
33. Trojaborg, W., Weimer, L. H., Hays, APOD. Electrophysiologic studies in critical illness associated weakness: myopathy or neuropathy–a reappraisal. Clin. Neurophysiol., 2001, 112, p. 1586–1593.
34. Rich, M. M., Pinter, M. J., Kraner, S. D., Barchi, R. L. Loss of electrical excitability in an animal model of acute quadriplegic myopathy. Ann. Neurol., 1998, 43, p. 171–179.
35. Wang, X., Li, Y., Engisch, K. L. et al. Activity-dependent presynaptic regulation of quantal size at the mammalian neuromuscular junction in vivo. J. Neurosci., 2005, 25, 2, p. 343–351.
36. Schweickert, W. D., Hall, J. ICU-acquired weakness. Chest, 2007, 135, 5, p. 1541–1549.
37. Kress, J. P., Pohlman, A. S., O’Connor, M. F. et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N. Engl. J. Med., 2000, 342, p. 1471–1477.
38. Zhang, Y., Hartmann, H. A., Satin, J. Glycosylation influences voltage-dependent gating of cardiac and skeletal muscle sodium channels. J. Membr. Biol., 1999, 171, p. 195–207.
39. Pappone, P. A. Voltage-clamp experiments in normal and denervated mammalian skeletal muscle fibres. J. Physiol., 1980, 306, p. 377–410.
40. Rich, M. M., Kraner, S. D., Barchi, R. L. Altered gene expression in steroid-treated denervated muscle. Neurobiol. Dis., 1999, 6, p. 515–522.
41. Bellinger, A. M., Mongillo, M., Marks, A. R. Stressed out: The skeletal muscle ryanodine receptor as a target of stress. J. Clin. Invest., 2008, 118, p. 445–453.
42. Capasso, M., Di Muzio, A., Pandolfi, A., Pace, M., Di Tomo, P., Ragno, M. Possible role for nitric oxide dysregulation in critical illness myopathy. Muscle Nerve, 2008, 37, p. 196–202.
43. Rossignol, B., Gueret, G., Pennec, J. P. et al. Effects of chronic sepsis on contractile properties of fast-twitch muscle in an experimental model of critical illness neuropathy in the rat. Crit. Care Med., 2008, 36, p. 1855–1836.
44. Dalla Libera, L., Ravara, B., Gobbo, V. et al. Skeletal muscle myofibrillar protein oxidation in heart failure and the protective effect of Carvediol. J. Mol. Cell. Cardiol., 2005, 38, p. 803–807.
45. Brealey, D., Brand, M., Hargreaves, I., Heales, S., Land, J., Smolenski, R. et al. Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet, 2002, 360, p. 219–223.
46. Carré, J. E. et al. Survival in critical illness is associated with early activation of mitochondrial biogenesis. Am. Respir. Crit. Care Med., 2010, 182, 6, p. 745–751.
47. Singer, M. Cellular dysfunction in sepsis. Clin. Chest. Med., 2008, 35, p. 655–660.
48. Exline, M. C., Crouser, E. D. Mitochondrial mechanism of sepsis-induced organ failure. Front. Biosci., 2008, 13, p. 5030–5041.
49. Trnka, J. et al. Antioxidant properties of MitoTEMPOL and its hydroxylamine. Free Radical Research, 2009, 43, 1, p. 4–12.
50. Dare, A. J. et al. A systematic review of experimental treatments for mitochondrial dysfunction in sepsis and multiple organ dysfunction syndrrome. Free Rad. Biol. Med., 2009, 47, p. 1517–1527.
51. Singer, M., Brealey, D. Mitochondrial dysfunction in sepsis. Biochem. Soc. Symp., 1999, 66, p. 149–166.
52. Frost, M. T., Wang, O., Moncada, S. M., Singer, M. Hypoxia accelerates nitric oxide-dependent inhibition of of mitochondrial complex I in activated macrophages. Am. J. Physiol. Regul. Integr. Comp. Physiol., 2004, 288, p. 394–400.
53. Mesotten, S., Swinnen, J. V., Vanderhoydonc, F. et al. Contribution of circulating lipids to the improved outcome of critical illness by glycemic control with intensive insulin therapy. J. Clin. Endocrinol. Metab., 2004, 89, p. 219–226.
54. Van den Berghe, G., Wilmer, A., Hermans, G. et al. Intensive insuline therapy in the medical ICU. N. Engl. J. Med., 2006, 354, p. 449–461.
55. NICE-SUGAR Study Investigators? Intensive versus conventional glucose control in critically ill patients. N. Engl. J. Med., 2009, 360, 13, p. 1283–1297.
56. Inzucchi, S. E., Siegel, M. D. Glucose control in the ICU – how tight is too tight? N. Engl. J. Med., 2009, 360, p. 1346–1349.
57. Langouche, L., Vanhorebeek, I., Vlasselaers, D. et al. Intensive insulin therapy protects the endothelium of critically ill patients. J. Clin. Invest., 2005, 115, p. 2277–2286.
58. Lewis, M. I., Lorusso, T. J., Zhan, W. Z. et al. Interactive effects of denervation and malnutrition on diaphragm structure and function. J. Appl. Physiol., 1996, 81, p. 2165–2172.
59. Reid, C. L., Campbell, I. T., Little, R. A. Muscle wasting and energy balance in critical illness. Clin. Nutr., 2004, 23, p. 273–280.
60. Shoewalter, C. J., Engel, A. G. Acute quadriplegic myopathy: analysis of myosin isoforms and evidence for calpain-mediated proteolysis. Muscle Nerve, 1997, 20, p. 316–322.
61. Di Giovanni, S., Molon, A., Broccolini, A. et al. Constitutive activation of MAPK cascade in acute quadriplegic myopathy. Ann. Neurol., 2004, 55, p. 195–206.
62. Bird, S. J., Rich, M. M. Critical illness myopathy and polyneuropathy. Curr. Neurol Neurosci. Rep., 2002, 2, p. 527–533.
63. Horinouchi, H., Kumamoto, T., Kimura, N. et al. Myosin loss in denervated rat soleus muscle after dexamethasone treatment. Pathobiology, 2005, 72, p. 108–116.
64. Lang, C. H., Frost, R. A., Vary, T. C. Regulation of muscle protein synthesis during sepsis and inflammation. Am. J. Physiol. Endocrinol. Metab., 2007, 293, 2, p. 453–459.
65. Latronico, N., Shehu, I., Seghelini, E. Neuromuscular sequelae of critical illness. Curr. Opin. Crit. Care, 2005, 11, p. 381–390.
66. Bondanelli, M., Zatelli, M. C., Ambrosio, M. R. et al. Systemic diseases. Pituitary, 2008, 11, 2, p. 187–207.
67. Lee, M. C., Wee, G. R., Kim, J. H. Apoptosis of skeletal muscle on steroid-induced myopathy in rats. J. Nutr., 2005, 135, p. 1806S–1808S.
Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2011 Issue 3
Most read in this issue
- Intensive Care Unit-Acquired Weakness
- Serotonine syndrome – Case report
-
Zajištění dýchacích cest – souhrny přednášek
Praha 11. 11. 2010 - Pitfalls of postoperative care following carotid artery surgery