Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands.
Wageningen University & Research, Division of Human Nutrition and Health, Wageningen, The Netherlands.
Curr Opin Crit Care. 2022 Aug 1;28(4):409-416. doi: 10.1097/MCC.0000000000000955. Epub 2022 Jul 5.
To summarize the incidence, features, pathogenesis, risk factors, and evidence-based therapies of prolonged intensive care unit (ICU) acquired weakness (ICU-AW). We aim to provide an updated overview on aspects of poor physical recovery following critical illness.
New physical problems after ICU survival, such as muscle weakness, weakened condition, and reduced exercise capacity, are the most frequently encountered limitations of patients with postintensive care syndrome. Disabilities may persist for months to years and frequently do not fully recover. Hormonal and mitochondrial disturbances, impaired muscle regeneration due to injured satellite cells and epigenetic differences may be involved in sustained ICU-AW. Although demographics and ICU treatment factors appear essential determinants for physical recovery, pre-ICU health status is also crucial. Currently, no effective treatments are available. Early mobilization in the ICU may improve physical outcomes at ICU-discharge, but there is no evidence for benefit on long-term physical recovery.
Impaired physical recovery is observed frequently among ICU survivors. The pre-ICU health status, demographic, and ICU treatment factors appear to be important determinants for physical convalescence during the post-ICU phase. The pathophysiological mechanisms involved are poorly understood, thereby resulting in exiguous evidence-based treatment strategies to date.
总结 ICU 获得性衰弱（ICU-AW）的发生率、特征、发病机制、危险因素和循证治疗方法。我们旨在提供一个关于危重病后身体恢复不良方面的最新概述。
存活 ICU 后的新的身体问题，如肌肉无力、虚弱状态和运动能力降低，是 ICU 后综合征患者最常遇到的限制。残疾可能持续数月至数年，并且经常无法完全恢复。激素和线粒体紊乱、受损卫星细胞导致的肌肉再生受损以及表观遗传差异可能与持续的 ICU-AW 有关。尽管人口统计学和 ICU 治疗因素似乎是身体恢复的重要决定因素，但 ICU 前的健康状况也至关重要。目前，尚无有效的治疗方法。ICU 内早期活动可能会改善 ICU 出院时的身体结局，但在长期身体恢复方面没有获益证据。
在 ICU 幸存者中经常观察到身体恢复受损。在 ICU 后阶段，ICU 前的健康状况、人口统计学和 ICU 治疗因素似乎是身体恢复的重要决定因素。涉及的病理生理机制了解甚少，因此迄今为止，循证治疗策略很少。
