ICU-acquired weakness: Impact on short- and long-term outcome

Greet Van den Berghe (Leuven, Belgium)

 

 

Complex pathophysiology with multiple mechanisms

MRC score requires cooperation of patient, does not distinguish between myopathy / neuropathy

Mostly non-volitional testing for pts who cannot cooperate; some differentiation between myopathy / neuropathy; direct muscle stimulation is NOT common in clinical practice

*Obesity is the only protective non-modifiable factor for weakness!

Modifiable risk factors that can be addressed: Avoid hyperglycaemia, avoid early Parenteral nutrition, aim to mobilise early

Short-term consequences include: ICU / hospital mortality, longer duration mech ventilation, extubation failure, swallowing disorders etc.

Long-term consequences include: post-ICU mortality, non-discharge to home, longer period of rehab, impaired functioning

Long term survival decreases with increasing severity of weakness

Longer ICU stay –> worsening weakness