Klawitter Felix, Walter Uwe, Axer Hubertus, Ehler Johannes
Klinik und Poliklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Deutschland.
Anaesthesiologie. 2023 Aug;72(8):543-554. doi: 10.1007/s00101-023-01300-5. Epub 2023 Jun 13.
Intensive care unit-acquired weakness (ICUAW) is one of the most common neuromuscular complications in intensive care medicine. The clinical diagnosis and assessment of the severity using established diagnostic methods (e.g., clinical examination using the Medical Research Council Sum Score or electrophysiological examination) can be difficult or even impossible, especially in sedated, ventilated and delirious patients. Neuromuscular ultrasound (NMUS) has increasingly been investigated in ICUAW as an easy to use noninvasive and mostly patient compliance-independent diagnostic alternative. It has been shown that NMUS appears to be a promising tool to detect ICUAW, to assess the severity of muscular weakness and to monitor the clinical progression. Further studies are needed to standardize the methodology, to evaluate the training effort and to optimize outcome predication. The formulation of an interdisciplinary neurological and anesthesiological training curriculum is warranted to establish NMUS as a complementary diagnostic method of ICUAW in daily clinical practice.
重症监护病房获得性肌无力（ICUAW）是重症监护医学中最常见的神经肌肉并发症之一。使用既定诊断方法（如采用医学研究委员会总评分的临床检查或电生理检查）进行临床诊断和严重程度评估可能很困难甚至无法进行，尤其是在接受镇静、机械通气和谵妄的患者中。神经肌肉超声（NMUS）作为一种易于使用的非侵入性且大多不依赖患者依从性的诊断方法，在ICUAW中受到越来越多的研究。已表明NMUS似乎是检测ICUAW、评估肌无力严重程度及监测临床进展的一种有前景的工具。需要进一步研究以规范方法、评估培训工作并优化结果预测。制定跨学科的神经学和麻醉学培训课程对于在日常临床实践中将NMUS确立为ICUAW的补充诊断方法是必要的。
