An Evaluation of The Pathophysiology, Prevention, and Rehabilitation Strategies for ICU-Acquired Weakness in Critically Ill Patients

Abstract

Critically ill patients are often exposed to Intensive Care Unit-Acquired Weakness (ICUAW). The pathophysiology of this condition, the preventative measures, as well as the effective rehabilitation approaches are the core for improving patient functional status and the decrease of the healthcare system burden. ICUAW is a general term that is used to include a range of neuropathies of critical importance such as preparing polyneuropathy (CIP) and critical illness myopathy (CIM), most of which can coexist during the same patient. ICUAW mechanisms can be quite subtle and complex. Several mechanisms include factors like oxidative stress, inflammation, and endothelial dysfunction. The suggested mechanisms involved are microvascular dysfunction, inflammatory responses, mitochondrial dysfunction, and neural excitation-contraction coupling failure. Nonetheless, it is fairly evident from the current data that there may be a multifactorial interplay at the basis of this illness, but the full picture continues to be obscure. The preventive strategies are targeted mostly at reducing the risk factors involved in the development of ICUAW. Strategies like early mobilization, paying due attention to the sedation strategies, and using third-generation short-acting neuromuscular blockers that can be reversed. Furthermore, technology based on electrical muscle stimulation is one of the tools being used for secondary prevention. Rehabilitation has a vital role in recovering patients from the ICUAW. The multidisciplinary approach is centered on rehabilitation development with physical therapy, occupational therapy, and respiratory therapy involvement as key elements of the overall care. Sustained exercise programs, respiratory therapy, and neuromuscular electrical stimulation are effective rehabilitation approaches in the treatment of these patients to restore muscle strength, function, and physical ability after their ICUAW. This review aims to reflect on the commonly encountered weakness in ICU patients to guide the relevant phyisicans on how to deal with them to improve the patient’s condition, even if by a small fraction.