The ICM research agenda on intensive care unit-acquired weakness

Nicola Latronico, Margaret Herridge, Ramona O. Hopkins, Derek Angus, Nicholas Hart, Greet Hermans, Theodore Iwashyna, Yaseen Arabi, Giuseppe Citerio, E. Wesley Ely, Jesse Hall, Sangeeta Mehta, Kathleen Puntillo, Johannes Van den Hoeven, Hannah Wunsch, Deborah Cook, Claudia Dos Santos, Gordon Rubenfeld, Jean Louis Vincent, Greet Van den BergheElie Azoulay, Dale M. Needham

Research output: Contribution to journalArticle

Abstract

We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle strength and function using nonvolitional tests may be useful, but comparison with established methods of global and specific muscle strength and physical function and determination of their reliability and normal values would be important to advance these techniques. Serial measurements of limb and respiratory muscle strength, and systematic screening for dysphagia, would be helpful to clarify if and how weakness of these muscle groups is independently associated with outcome. ICUAW, delirium, and sedatives and analgesics may interact with each other, amplifying the effects of each individual factor. Reduced mobility in patients with hypoactive delirium needs investigations into dysfunction of central and peripheral nervous system motor pathways. Interventional nutritional studies should include muscle mass, strength, and physical function as outcomes, and prioritize elucidation of mechanisms. At follow-up, ICU survivors may suffer from prolonged muscle weakness and wasting and other physical impairments, as well as fatigue without demonstrable weakness on examination. Further studies should evaluate the prevalence and severity of fatigue in ICU survivors and define its association with psychiatric disorders, pain, cognitive impairment, and axonal loss. Finally, methodological issues, including accounting for baseline status, handling of missing data, and inclusion of patient-centered outcome measures should be addressed in future studies.

Original languageEnglish (US)
Pages (from-to)1270-1281
Number of pages12
JournalIntensive Care Medicine
Volume43
Issue number9
DOIs
StatePublished - Sep 1 2017

Keywords

  • Disability
  • Fatigue
  • Muscle weakness
  • Myopathy
  • Pain
  • Physical impairment
  • Polyneuropathy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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  • Cite this

    Latronico, N., Herridge, M., Hopkins, R. O., Angus, D., Hart, N., Hermans, G., Iwashyna, T., Arabi, Y., Citerio, G., Wesley Ely, E., Hall, J., Mehta, S., Puntillo, K., Van den Hoeven, J., Wunsch, H., Cook, D., Dos Santos, C., Rubenfeld, G., Vincent, J. L., ... Needham, D. M. (2017). The ICM research agenda on intensive care unit-acquired weakness. Intensive Care Medicine, 43(9), 1270-1281. https://doi.org/10.1007/s00134-017-4757-5