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ICU-AW — Intensive Care Unit-Acquired Weakness (Polyneuropathy/Myopathy)

Diagnosis and rehabilitation of critical illness polyneuropathy (CIP) and myopathy (CIM) that develop during prolonged ICU stays.

Written by: Saygı Hospital Health Guide Editorial Board
Published: · Last updated:

This content is for general information; please consult your physician for diagnosis and treatment.

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What is ICU-AW — Intensive Care Unit-Acquired Weakness (Polyneuropathy/Myopathy)?

ICU-AW (Intensive Care Unit-Acquired Weakness) is a generalized, symmetric, predominantly proximal muscle weakness developing in patients with ventilator or ICU stays ≥7-10 days. Incidence is 25% (clinical assessment) to 75% (electrophysiologic). Three subtypes: critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and both (combined — most common).

Clinical features — symmetric muscle weakness, proximal dominant, reduced/absent reflexes, variable sensory deficit (CIP has sensory involvement, CIM does not), facial muscles usually spared. Difficulty weaning from the ventilator (diaphragmatic involvement) is often the first clue.

Pathogenesis — sepsis-driven cytokine cascade, SIRS, hyperglycemia, concurrent steroids + NMB (especially in ARDS), immobilization (muscle atrophy of 2-3% per day). Axonal damage (CIP) plus muscle-membrane dysfunction / myosin loss (CIM).

Diagnosis — MRC (Medical Research Council) muscle-strength score assesses 12 muscle groups (max 60); <48 diagnoses ICU-AW. Electrophysiology: low CMAP amplitude (axonal), low SNAP (sensory — CIP), normal/slightly decreased conduction velocity, spontaneous activity in myopathy.

Symptoms

Difficulty weaning from mechanical ventilation — weakness of respiratory muscles on SBT, diaphragmatic dysfunction
Generalized weakness — symmetric in arms and legs, proximal dominant; inability to lift the foot or hold the arm up
Reduced or absent deep tendon reflexes (particularly in CIP)
Sensory deficit — paresthesia, reduced pain threshold (prominent in CIP; absent in CIM)
Functional scales — ICU Mobility Scale, Barthel Index: marked decline from baseline

Risk Factors

Sepsis and SIRS — strongest independent risk factor (OR 2-3)
Prolonged mechanical ventilation (>7 days), immobilization, length of ICU stay
Hyperglycemia plus corticosteroid use (high dose, prolonged)
Prolonged neuromuscular blockade (NMB) (>48-72 hours, especially combined with steroids)
Older age, pre-existing muscle/neurological disease, female sex, renal replacement therapy

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Routine ICU-AW risk assessment at ICU admission with a prevention bundle
  • From day 7 onward, weekly MRC muscle-strength assessment (if the patient is cooperative)
  • Difficulty weaning + generalized weakness — suspect ICU-AW and request electrophysiology

Treatment Methods

01
Prevention — early mobilization (from day 1-3, passive ROM in bed → active → sitting in a chair → ambulation), glycemic control (140-180 mg/dL; overly strict control risks hypoglycemia), minimize sedation (light sedation, daily SAT), limit NMB (avoid for more than 48 hours unless strongly indicated)
02
Physiotherapy — early intensive physiotherapy (starting day 1), twice-daily sessions, progressing from passive ROM → active ROM → resistive → functional. Neurophysiotherapy/electrotherapy in selected cases (NMES — neuromuscular electrical stimulation)
03
Nutrition optimization — adequate protein (1.2-2 g/kg IBW), micronutrients (vitamin D, B vitamins); care in sarcopenic-obese patients
04
Diagnosis — weekly MRC (in cooperative patients), electrophysiology (EMG-NCS) if needed; rule out other causes (Guillain-Barré, myasthenia, botulism, neuroleptic malignant syndrome, severe hypokalemia)
05
Rehabilitation — rehabilitation center or home physiotherapy after ICU discharge; recovery takes weeks to months; muscle mass may not fully recover
06
Long-term follow-up — functional independence assessment, quality-of-life scales; integrated with post-ICU syndrome management

Which Department to Visit?

You can visit our Göğüs Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.