Paresis following mechanical ventilation

Abstract

Purpose of review: To review the medical literature on neuromuscular abnormalities acquired in the intensive care unit (ICU), particularly after mechanical ventilation, focusing on the most recent advances in this field.

Recent finding: Using a simple bedside muscle strength score, significant clinical weakness is detected in one fourth of patients awakening in ICU after more than 1 week of mechanical ventilation. Weakness is associated with a longer time on mechanical ventilation, although the exact relationship between limb and respiratory neuromuscular involvement remains unclear. Muscle involvement is often combined with axonal involvement and can predominate or occur in isolation in some patients. Although prolonged severe weakness is unusual, milder abnormalities may persist for several months after discharge. In addition to severity and duration of initial organ failures, both neuromuscular inactivity and use of corticosteroids make an independent contribution of the neuromuscular abnormalities. Conversely, strict glycemic control may prevent neuromuscular abnormalities, although this needs to be confirmed in general ICU patients.

Summary: Avoiding complete neuromuscular inactivity, using corticosteroids with greater discernment, and closely monitoring blood glucose levels might be worthwhile avenues for research in prevention of neuromuscular abnormalities acquired in the most severely ill ICU patients. Investigations of the severity of the respiratory neuromuscular involvement are also warranted.