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A guided approach to diagnose severe muscle weakness in the intensive care unit.

Latronico N, Gosselink R - Rev Bras Ter Intensiva (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, Critical Care Medicine and Emergency, Spedali Civili University Hospital, Brescia, IT.

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Intensive care unit (ICU) acquired muscle weakness (ICUAW) is a clinically detectedcondition characterized by diffuse, symmetric weakness involving the limbs and respiratorymuscles... A diagnosis of ICUAW is achieved by manually testing the muscle strength using the MedicalResearch Council (MRC) scale or by measuring handgrip strength using a dynamometer... Recently, a simplified version of the scale with only fourcategories and improved clinimetric properties was proposed (Figure 2)... To date, thisversion has been validated in a small cohort of 60 critically ill patients with excellentinter-rater reliability and high sensitivity and specificity in diagnosing ICUAW comparedto complete full MRC... However, voluntary muscle strength using the MRCsum score or handgrip dynamometry can be reliably assessed if adequate clinical experienceis gained with manual muscle testing in ICU patients and strict guidelines and the use ofstandardized test procedures and positions are followed to accurately selectpatients... Common causes of ICUAW include critical illness polyneuropathy (CIP) and myopathy (CIM),which are revealed by appropriate nerve conduction studies and electromyography... A single nerve test (the peroneal nervetest) has been validated in two multicenter studies as a 100% sensitivity test compared toa complete nerve conduction study and electromyography in the diagnosis ofCIP/CIM, and it can beperformed in 10 minutes... A reducedamplitude of the muscle action potential obtained after direct muscle stimulation canidentify muscle membrane excitability and CIM in non-cooperative patients and can be usefulin differentiating CIM from CIP in the ICU... In the ICU, severe muscle weakness is independentlyassociated with prolonged mechanical ventilation, ICU stay, hospital stay and increasedmortality... Patients developingweakness during the ICU stay have reduced quality of life and increased mortality 1 yearafter ICU discharge... In survivors ofacute lung injury, ICUAW resolves within several weeks to months in most patients, but itcan persist longer in other patients... In a recent Brazilian cohort study,physical activity, muscle strength and exercise capacity were significantly reduced insurvivors of severe sepsis and septic shock... In conclusion, muscle weakness acquired during the ICU stay is a clinically relevantcomplication with an impact on early and late outcome... Timely diagnosis is much deservedfor patients, and pragmatic diagnostic flow-charts, as proposed here, may be of help indaily practice.

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Related in: MedlinePlus

Diagnostic algorithm for intensive care unit acquired muscle weakness (ICUAW).Modified from: Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy:a major cause of muscle weakness and paralysis. Lancet Neurol.2011;10(10):931-41.(1)Cut-off handgrip strength values were below 7kg for female and below 11Kg for males.DD - differential diagnosis; NCS - nerve conduction study; EMG - electromyography; NM- neuromuscular; CIP - critical illness polyneuropathy; CIM - critical illnessmyopathy; MRC - Medical Research Council; CMAP - compound muscle actionpotential.
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f01: Diagnostic algorithm for intensive care unit acquired muscle weakness (ICUAW).Modified from: Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy:a major cause of muscle weakness and paralysis. Lancet Neurol.2011;10(10):931-41.(1)Cut-off handgrip strength values were below 7kg for female and below 11Kg for males.DD - differential diagnosis; NCS - nerve conduction study; EMG - electromyography; NM- neuromuscular; CIP - critical illness polyneuropathy; CIM - critical illnessmyopathy; MRC - Medical Research Council; CMAP - compound muscle actionpotential.

Mentions: Intensive care unit (ICU) acquired muscle weakness (ICUAW) is a clinically detectedcondition characterized by diffuse, symmetric weakness involving the limbs and respiratorymuscles.(1) Patients have differentdegrees of limb muscle weakness and are dependent on a ventilator, while the facial musclesare spared. Diagnosis of ICUAW requires that no plausible etiology other than criticalillness be identified, and thus, other causes of acute muscle weakness are excluded. Onemajor diagnostic criterion is that ICUAW is detected after the onset of critical illness;therefore, it is important to differentiate ICUAW from Guillain-Barrè syndrome orother acute neuromuscular disorders that may cause respiratory failure and ICU admission(Figure 1).(1) The use of neuromuscular blocking agents for long periods of time,the use of some antibiotics and electrolyte abnormalities, such as hypermagnesemia,hypokalemia, hypercalcemia, and hypophosphatemia, and prolonged immobilization are commonin the ICU and should be appropriately treated before a diagnosis of ICUAW isposed.(2)


A guided approach to diagnose severe muscle weakness in the intensive care unit.

Latronico N, Gosselink R - Rev Bras Ter Intensiva (2015)

Diagnostic algorithm for intensive care unit acquired muscle weakness (ICUAW).Modified from: Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy:a major cause of muscle weakness and paralysis. Lancet Neurol.2011;10(10):931-41.(1)Cut-off handgrip strength values were below 7kg for female and below 11Kg for males.DD - differential diagnosis; NCS - nerve conduction study; EMG - electromyography; NM- neuromuscular; CIP - critical illness polyneuropathy; CIM - critical illnessmyopathy; MRC - Medical Research Council; CMAP - compound muscle actionpotential.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592111&req=5

f01: Diagnostic algorithm for intensive care unit acquired muscle weakness (ICUAW).Modified from: Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy:a major cause of muscle weakness and paralysis. Lancet Neurol.2011;10(10):931-41.(1)Cut-off handgrip strength values were below 7kg for female and below 11Kg for males.DD - differential diagnosis; NCS - nerve conduction study; EMG - electromyography; NM- neuromuscular; CIP - critical illness polyneuropathy; CIM - critical illnessmyopathy; MRC - Medical Research Council; CMAP - compound muscle actionpotential.
Mentions: Intensive care unit (ICU) acquired muscle weakness (ICUAW) is a clinically detectedcondition characterized by diffuse, symmetric weakness involving the limbs and respiratorymuscles.(1) Patients have differentdegrees of limb muscle weakness and are dependent on a ventilator, while the facial musclesare spared. Diagnosis of ICUAW requires that no plausible etiology other than criticalillness be identified, and thus, other causes of acute muscle weakness are excluded. Onemajor diagnostic criterion is that ICUAW is detected after the onset of critical illness;therefore, it is important to differentiate ICUAW from Guillain-Barrè syndrome orother acute neuromuscular disorders that may cause respiratory failure and ICU admission(Figure 1).(1) The use of neuromuscular blocking agents for long periods of time,the use of some antibiotics and electrolyte abnormalities, such as hypermagnesemia,hypokalemia, hypercalcemia, and hypophosphatemia, and prolonged immobilization are commonin the ICU and should be appropriately treated before a diagnosis of ICUAW isposed.(2)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, Critical Care Medicine and Emergency, Spedali Civili University Hospital, Brescia, IT.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Intensive care unit (ICU) acquired muscle weakness (ICUAW) is a clinically detectedcondition characterized by diffuse, symmetric weakness involving the limbs and respiratorymuscles... A diagnosis of ICUAW is achieved by manually testing the muscle strength using the MedicalResearch Council (MRC) scale or by measuring handgrip strength using a dynamometer... Recently, a simplified version of the scale with only fourcategories and improved clinimetric properties was proposed (Figure 2)... To date, thisversion has been validated in a small cohort of 60 critically ill patients with excellentinter-rater reliability and high sensitivity and specificity in diagnosing ICUAW comparedto complete full MRC... However, voluntary muscle strength using the MRCsum score or handgrip dynamometry can be reliably assessed if adequate clinical experienceis gained with manual muscle testing in ICU patients and strict guidelines and the use ofstandardized test procedures and positions are followed to accurately selectpatients... Common causes of ICUAW include critical illness polyneuropathy (CIP) and myopathy (CIM),which are revealed by appropriate nerve conduction studies and electromyography... A single nerve test (the peroneal nervetest) has been validated in two multicenter studies as a 100% sensitivity test compared toa complete nerve conduction study and electromyography in the diagnosis ofCIP/CIM, and it can beperformed in 10 minutes... A reducedamplitude of the muscle action potential obtained after direct muscle stimulation canidentify muscle membrane excitability and CIM in non-cooperative patients and can be usefulin differentiating CIM from CIP in the ICU... In the ICU, severe muscle weakness is independentlyassociated with prolonged mechanical ventilation, ICU stay, hospital stay and increasedmortality... Patients developingweakness during the ICU stay have reduced quality of life and increased mortality 1 yearafter ICU discharge... In survivors ofacute lung injury, ICUAW resolves within several weeks to months in most patients, but itcan persist longer in other patients... In a recent Brazilian cohort study,physical activity, muscle strength and exercise capacity were significantly reduced insurvivors of severe sepsis and septic shock... In conclusion, muscle weakness acquired during the ICU stay is a clinically relevantcomplication with an impact on early and late outcome... Timely diagnosis is much deservedfor patients, and pragmatic diagnostic flow-charts, as proposed here, may be of help indaily practice.

No MeSH data available.


Related in: MedlinePlus