الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Intensive Care Unit Acquired Weakness (ICUAW) is syndrome of generalized limb weakness that develops while the patient is critically ill and for which there is no alternative explanation other than the critical illness itself.
ICUAW is clinically detected weakness in critically ill patients in whom there is no etiology other than critical illness. Patients with ICUAW are then classified into those with critical illness polyneuropathy (CIP), critical illness myopathy (CIM), critical illness neuromyopathy (CINM). Those with (CIM) are further subclassified histologically into: cachectic myopathy, thick filament myopathy, and necrotizing myopathy.
Reasons for the development of muscle weakness are multifactorial, including premorbid conditions (for example, malignancy), as well as conditions that the patient may developed in the ICU, such as systemic inflammation, prolonged ventilation, and prolonged bed rest. The occurrence of ICUAW varies considerably depending on the patient case, diagnostic method used, and the timing of examination.
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The muscles of patients with ICUAW demonstrate a range of alterations, muscle strength depends on the force-generating capacity of the muscle and the muscle mass, and both are thought to be affected in ICUAW. Clinically, this manifests as muscle wasting preceded by abnormal. Muscle electrophysiology. A key feature of the disease is a marked loss of thick myosin filaments with disruption to the actin: myosin ratio and a disruption of the myofilament organisation of the tissue. Other mechanisms that contribute to the loss of power include neuropathy, a reduction in energy generation by the muscle through insulin resistance and mitochondrial dysfunction, dysregulation of calcium handling and electrical inexcitability.
ICUAW is an important complication that contributes to functional disability and decreased quality of life in ICU survivors. Indeed, it is an important component of the post-intensive care syndrome (PCIS) representing any new or worsening impairment in physical, cognitive, or mental heath status following an acute care hospitalization. Early rehabilitation may be an important preventative therapy for ICUAW, but there are many important barriers at the patient, provider, and organizational levels which need to be recognized and overcome. Novel rehabilitation (for example, NMES, cycle ergometry
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technology may facilitate rehabilitation in patients who cannot actively participate in therapy during the acute phase of their illness.
The combination of: (1) a coordinated interdisciplinary team; (2) novel advances in both ICU and rehabilitation technology; and (3) a culture that prioritizes early rehabilitation, will help our ICU patients to be awake, calm, cooperative, and mobile, and hopefully translate into substantial improvements in both their short-term and long-term outcomes.