Acute Crit Care.  2023 Nov;38(4):409-424. 10.4266/acc.2023.00703.

Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review

• Elkalawy H
• Sekhar P
• Abosena W

• KMID: 2550897
• DOI: http://doi.org/10.4266/acc.2023.00703

Abstract

Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.

Keyword

computed tomography; critical illness; diagnosis; intensive care units; muscle weakness; ultrasound

Figure

• 

  Figure 1. Pathophysiology, risk factors, and consequences of intensive care unit-acquired weakness (ICU-AW). ADLS: activity of daily livings; TNF: tumor necrosis factor; IL: interleukin.a) Drugs: like vasoactive medication as B-Blockers (+), corticosteroids (±), neuromuscular blocking agents (–) combined with corticosteroids infused for more than 48 hours (+), certain antibiotics as clindamycin, erythromycin, quinolones, polymyxin, tetracycline and vancomycin which act on neuromuscular junction but not proven to be the sole cause for ICU-AW (±).

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