CHU de Lille, médecine intensive-réanimation, 59000 Lille, France; CHU de Lille, department of clinical neurophysiology, 59000 Lille, France.
CHU de Lille, centre de référence des maladies neuromusculaires, 59000 Lille, France.
Rev Neurol (Paris). 2022 Jan-Feb;178(1-2):84-92. doi: 10.1016/j.neurol.2021.12.007. Epub 2022 Jan 5.
Intensive care unit (ICU)-acquired weakness (ICU-AW) is defined as clinically detected weakness in critically ill patients in whom there is no plausible etiology other than critical illness. Using electrophysiological methods, patients with ICU-AW are classified in three subcategories: critical illness polyneuropathy, critical illness myopathy and critical illness neuromyopathy. ICU-AW is a frequent complication occurring in critical ill patients. Risk factors include illness severity and organ failure, age, hyperglycemia, parenteral nutrition, drugs and immobility. Due to short- and long-term complications, ICU-AW results in longer hospital stay and increased mortality. Its management is essentially preventive avoiding modifiable risk factors, especially duration of sedation and immobilization that should be as short as possible. Pharmacological approaches have been studied but none have proven efficacy. In the present review, we propose practical questions that the clinician should ask in case of acquired weakness during ICU stay: when to suspect ICU-AW, what risk factors should be identified, how to diagnose ICU-AW, what is the prognosis and how can recovery be improved?
重症加强治疗病房获得性肌无力（ICU-AW）定义为危重病患者出现临床可检测到的肌无力，且无除危重病以外的其他合理病因。使用电生理学方法，可将 ICU-AW 患者分为以下三个亚类：危重病性多发性神经病、危重病性肌病和危重病性肌神经病。ICU-AW 是危重病患者中常见的并发症。危险因素包括疾病严重程度和器官衰竭、年龄、高血糖、肠外营养、药物和活动受限。由于短期和长期并发症，ICU-AW 导致住院时间延长和死亡率增加。其治疗主要是预防，避免可改变的危险因素，尤其是镇静和固定的时间应尽可能缩短。已研究了药物治疗方法，但均未证明有效。在本综述中，我们提出了临床医生在 ICU 入住期间出现获得性肌无力时应提出的实际问题：何时怀疑 ICU-AW，应识别哪些危险因素，如何诊断 ICU-AW，预后如何，如何改善恢复？
