Acquired Neuromuscular Weakness and Early Mobilization in the Intensive Care Unit

* Clinical Fellow, Critical Care Medicine, Department of Anesthesia and Perioperative Care, † Medical Director, Critical Care Medicine, and Professor and Executive Vice Chairman, Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California.
Anesthesiology (Impact Factor: 5.88). 08/2012; 118(1). DOI: 10.1097/ALN.0b013e31826be693
Source: PubMed


Survival from critical illness has improved in recent years, leading to increased attention to the sequelae of such illness. Neuromuscular weakness in the intensive care unit (ICU) is common, persistent, and has significant public health implications. The differential diagnosis of weakness in the ICU is extensive and includes critical illness neuromyopathy. Prolonged immobility and bedrest lead to catabolism and muscle atrophy, and are associated with critical illness neuromyopathy and ICU-acquired weakness. Early mobilization therapy has been advocated as a mechanism to prevent ICU-acquired weakness. Early mobilization is safe and feasible in most ICU patients, and improves outcomes. Implementation of early mobilization therapy requires changes in ICU culture, including decreased sedation and bedrest. Various technologies exist to increase compliance with early mobilization programs. Drugs targeting muscle pathways to decrease atrophy and muscle-wasting are in development. Additional research on early mobilization in the ICU is needed.


Available from: Michael Gropper, Apr 15, 2015
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    • "The voltage gated sodium channels (Na V ) are strongly involved in the triggering and in the propagation of muscle action potential (AP) and hence in membrane excitability. Two isoforms have been described in adult skeletal muscle: Na V 1.4 and Na V 1.5 [4] [5] [6]. Na V dysfunction leading to a decrease in muscle membrane excitability was observed during chronic sepsis in man [7] [8] [9] and in animal [6] or after lipopolysaccharides (LPSs) [10] or TNFa injection [2]. "
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    ABSTRACT: One of the main factor involved neuromyopathy acquired in intensive care unit (ICU) appears to be sepsis. It induces the release of many pro- and anti-inflammatory factors which can directly modulate the muscle excitability. We have studied the effects of one of them: the ciliary nervous trophic factor (CNTF) which is a cytokine released in the early phase of sepsis. CNTF induces a decrease in the sodium current and an increase in resting potential as in sodium inversion potential. These effects could participate to the hypo-excitability observed during sepsis and could be involved in the ICU acquired neuromyopathy. As for TNFα, this early effect is mainly mediated by protein kinase C (PKC) activation and appears to be a reversible post-transcriptional effect.
    Cytokine 05/2013; 63(1). DOI:10.1016/j.cyto.2013.04.023 · 2.66 Impact Factor

  • Anesthesiology 02/2013; 118(4). DOI:10.1097/ALN.0b013e318288823b · 5.88 Impact Factor
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    ABSTRACT: BACKGROUND: Long-term weakness and disability are common following an Intensive Care Unit (ICU) stay. Usual care in the ICU prevents most patients from receiving preventitive early mobilization. OBJECTIVE: To describe the quality improvement (QI) program established by a physical therapist at UCSF Medical Center from 2009 to 2011 to increase the number of patients in the ICU receiving physical therapy, and decrease the length of time after ICU admission to initiate physical therapy, contributing to a reduction is patients' ICU length of stay. DESIGN: This study was a nine month retrospective before/after quality improvement project. METHODS: An interprofessional ICU Early Mobilization Group established and promoted guidelines to mobilize patients in the ICU. One physical therapist was dedicated to a 16 bed medical-surgical ICU to provide qualifying patients in the ICU physical therapy within 48 hours of their ICU admission. Patients receiving early physical therapy intervention in the ICU in 2010 were compared with patients who received physical therapy under usual care practice in the same ICU in 2009. RESULTS: From 2009 to 2010, the number of patients receiving physical therapy in the ICU increased from 179 to 294. Median time (Interquartile Range) from ICU admission to physical therapy evaluation was 3 (9) days in 2009 and 1 (3) day in 2010. ICU length of stay, on average, decrease by two days, and the percentage of ambulatory patients discharged to home increased from 55%to 77%. LIMITATIONS: This QI project relied upon retrospective data collection from 6 separate collectors and the intervention lacked 7 day per week physical therapy coverage. CONCLUSIONS: These outcome improvements demonstrated the value and feasibility of a physical therapist-led early mobility program.
    Physical Therapy 04/2013; 93(7). DOI:10.2522/ptj.20110420 · 2.53 Impact Factor
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