Presentation and management of ICU myopathy and neuropathy.

Purpose of review
Critical illness myopathy and neuropathy are common complications in the ICU, causing
limb and respiratory muscle weakness.Wereview the most recent data concerning their
presentation, diagnosis and treatment.
Recent findings
Limb muscle strength can be reliably assessed by using the Medical Research Council
scale or handgrip dynamometry. A Medical Research Council sum score below
48 or mean Medical Research Council score below 4 (antigravity strength) across all
testable muscle groups, and a force value of less than 11 kg-force for men and less than
7 kg-force for women at dominant-hand dynamometry identify ICU-acquired weakness
in previously healthy individuals admitted to an ICU for nonneuromuscular disorder.
Clinical signs, together with measurements of the maximal inspiratory and expiratory
pressures and vital capacity, are important to timely diagnose respiratory muscle
weakness. Electrophysiological testing is usefully implemented in unconscious patients
or in awake patients who do not improve despite appropriate treatments. Early
physiotherapy in the ICU can increase the proportion of patients reaching an
independent functional status following their ICU stay. Critical illness myopathy and
neuropathy may occur outside the ICU; however, exact estimates are lacking.
Summary
Systematic application of diagnostic criteria and early physiotherapy may help clinicians
to timely diagnose critical illness myopathy and neuropathy and to reduce the
associated morbidity.
Keywords
critical illness myopathy, critical illness polyneuropathy, electromyography,