Prevention and Treatment of ICU Acquired Weakness – Is There a Stimulating Answer?
Abstract
ICU acquired weakness (ICUAW) complicates critical illness and is an important determinant of acute and long term outcomes. The consequences of ICUAW are profound. Respiratory muscle weakness prolongs duration of mechanical ventilation, contributes to weaning failure, impacts rates of reintubation after failed extubation, and is associated with poor outcomes including increased transfers to long term acute care facilities and death (1, 2). Likewise, limb muscle weakness limits ambulation, performance of activities of daily living, and impacts patient morbidity for years (3, 4). Survival after the acute episode of critical illness places an enormous burden on patients, families, and healthcare systems (1, 5). As a result, intensivists strive to develop effective rehabilitation strategies to prevent or treat this devastating complication.
In this issue of Critical Care Medicine, Parry et al (6) provide an excellent review of previously published randomized controlled trials that examined the use of neuromuscular electrical stimulation (NMES) to treat or attenuate limb muscle weakness in a general population of critically ill patients. Using rigorous predetermined criteria, the authors evaluated studies which included six cohorts of patients (138 total subjects). They provide a detailed analysis and side-by-side comparison of these prior studies, including a well-synthesized and thoughtful discussion that delineates what we have learned thus far from the application of NMES in…
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