School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada.
J Appl Physiol (1985). 2021 May 1;130(5):1479-1489. doi: 10.1152/japplphysiol.00019.2021. Epub 2021 Mar 18.
Critical illness-associated weakness (CIAW) is an umbrella term used to describe a group of neuromuscular disorders caused by severe illness. It can be subdivided into three major classifications based on the component of the neuromuscular system (i.e. peripheral nerves or skeletal muscle or both) that are affected. This includes critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and an overlap syndrome, critical illness polyneuromyopathy (CIPNM). It is a common complication observed in people with critical illness requiring intensive care unit (ICU) admission. Given CIAW is found in individuals experiencing grave illness, it can be challenging to study from a practical standpoint. However, over the past 2 decades, many insights into the pathophysiology of this condition have been made. Results from studies in both humans and animal models have found that a profound systemic inflammatory response and factors related to bioenergetic failure as well as microvascular, metabolic, and electrophysiological alterations underlie the development of CIAW. Current management strategies focus on early mobilization, achieving euglycemia, and nutritional optimization. Other interventions lack sufficient evidence, mainly due to a dearth of large trials. The goal of this Physiology in Medicine article is to highlight important aspects of the pathophysiology of these enigmatic conditions. It is hoped that improved understanding of the mechanisms underlying these disorders will lead to further study and new investigations for novel pharmacologic, nutritional, and exercise-based interventions to optimize patient outcomes.
危重病相关肌无力（CIAW）是一个用来描述由严重疾病引起的一组神经肌肉疾病的总称。它可以根据受影响的神经肌肉系统的组成部分（即周围神经或骨骼肌或两者）分为三大类。这包括危重病性多发性神经病（CIP）、危重病性肌病（CIM）和重叠综合征，危重病性多发性神经病（CIPNM）。它是重症监护病房（ICU）入住患者常见的并发症。鉴于 CIAW 发生在患有重病的个体中，从实际角度进行研究具有挑战性。然而，在过去的 20 年中，人们对这种疾病的病理生理学有了许多了解。人类和动物模型研究的结果发现，严重的全身炎症反应以及与生物能量衰竭、微血管、代谢和电生理学改变相关的因素是 CIAW 发展的基础。目前的治疗策略侧重于早期运动、实现血糖正常和营养优化。其他干预措施缺乏足够的证据，主要是由于缺乏大型试验。这篇《医学生理学》文章的目的是强调这些神秘疾病的病理生理学的重要方面。希望对这些疾病的机制的深入理解将导致进一步的研究和新的药理学、营养和运动干预的调查，以优化患者的结果。
