RT Journal Article
SR Electronic
T1 Weakness on the intensive care unit
JF Practical Neurology
JO Pract Neurol
FD BMJ Publishing Group Ltd
SP 280
OP 295
DO 10.1136/jnnp.2008.157263
VO 8
IS 5
A1 R S Howard
A1 S V Tan
A1 W J Z’Graggen
YR 2008
UL http://pn.bmj.com/content/8/5/280.abstract
AB Patients who are recovering from critical illness may be weak and difficult to wean from ventilatory support as a complication of their underlying disorder, intercurrent events or treatment given during prolonged intensive care. These patients are difficult to assess because of the severity of their weakness and any accompanying encephalopathy. It is essential to undertake a meticulous review, including assessment of any septic, hypoxic or metabolic derangements and a detailed look at the dosage and duration of medication including antibiotics, neuromuscular junction blocking agents and sedation. If a primary underlying neurological cause or an intercurrent event have been excluded, the likeliest cause of weakness is one of the neuromuscular complications of critical care such as: critical care polyneuropathy, an acute axonal neuropathy which develops in patients with preceding sepsis or multi-organ failure; the use of neuromuscular junction blocking agents or steroids; and critical illness myopathy, which is the most common cause of critical care related weakness.