Abstract
BackgroundIntensive care unit acquired weakness (ICUAW), embraces an array of disorders labeled “critical illness polyneuropathy” (CIP), “critical illness myopathy” (CIM) or “critical illness polyneuromyopathy” (CIPNM). Several studies have addressed the various characteristics of ICUAW, but the recovery is still unclear.ObjectiveThe present review investigated the recovery and the long-term functional outcome of subjects with ICUAW, whether the types of ICUAW have different outcomes and whether there is any supporting evidence.MethodsLiterature search was performed from MEDLINE/PubMed, CINAHL, EMBASE, PeDro, Web of Science and Scopus. Inclusion criteria were: i) sample size including five or more subjects; ii) subjects who suffered from ICUAW and/or CIP, CIM and CIP/CIM; iii) ICUAW ascertained by EMG. Follow-ups longer than one year were defined as long-term.ResultsTwenty-nine studies met the inclusion criteria. In total, 788 subjects with ICUAW were enrolled: 159 (20.1%) died and 588 (74.6%) were followed. Of all the included patients, 613 (77.7%) had CIP, 82 (10.4%) CIM and 56 (7.1%) CIP/CIM. Overall, 70.3% of the subjects with ICUAW fully recovered. Seven (24.1%) studies had a follow-up longer than 1 year (range 2–8) with 173 (21.9%) subjects enrolled globally and 108 followed. Of these subjects, 88.8% gained full recovery. Most of the studies did not use proper functional scales and only 4 and 3 studies employed the Barthel scale and the Functional Independence Measure (FIM) scale. Differentiation between the types of ICUAW was performed in 7 studies, but only 3 studies reported that subjects with CIM had a better prognosis and earlier recovery than subjects with CIP/CIM.ConclusionsSubjects with ICUAW could achieve good recovery and could improve at follow-up. However, the quality of the published studies due to short follow-ups and the paucity of defined outcome measures require confirms.
Highlights
A number of studies have been published about the muscle weakness that may affect intensive care unit (ICU) survivors
Despite the lack of treatments and the limitations of rehabilitative strategies, it was reported that 55–70% of subjects reached a full recovery after ICU discharge [21, 22], and that recovery depended on the type of Intensive care unit acquired weakness (ICUAW), as confirmed by the fact that critical illness myopathy” (CIM) had an earlier and better functional outcome than critical illness polyneuropathy” (CIP) [22, 23]
Inclusion criteria were: i) sample size including five or more subjects; ii) subjects who suffered from ICUAW and/or the following types: CIP, CIM and CIP/CIM; iii) ICUAW ascertained by EMG; iv) studies with mixed samples that used the definition of ICUAW, but subjects with CIP, CIM or CIP/CIM were considered; v) follow-up and outcome
Summary
A number of studies have been published about the muscle weakness that may affect intensive care unit (ICU) survivors This disorder, which in the intensive care literature is better known as ICU acquired weakness (ICUAW), embraces a spectrum of clinical conditions. After the first description by Bolton et al at the beginning of the’ s [4], a number of studies have been published that have contributed to making remarkable advances in the understanding of the complex aspects of ICUAW, such as the electrophysiological [5] and histological features [6] as well as the pathogenic mechanisms The occurrence of this disorder has been variously detected with a range from 45 to 80% [7,8,9]. Several studies have addressed the various characteristics of ICUAW, but the recovery is still unclear
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