From the Guidelines
Neuromuscular diseases in the ICU are characterized by impairments of physical functions, including neuromuscular functions of swallowing, breathing, mobility, and personal autonomy, as outlined in the guideline on multimodal rehabilitation for patients with post-intensive care syndrome 1. These impairments can be observed in critically ill patients after treatment in an ICU and are often summarized as “intensive care unit-acquired weakness” (ICU-AW) 1. The symptoms and outcomes experienced by critically ill patients are subsumed under the term post-intensive care syndrome (PICS), which consists of a neurologically heterogenous complex of impairments that can be observed in critically ill patients after treatment in an ICU 1. Some key points about neuromuscular diseases in the ICU include:
- Impairments of neuromuscular functions after acute respiratory distress syndrome (ARDS) are reported in at least 25% of patients 1
- The prevalence of cognitive impairments in ICU-survivors is reported as 25–40% after 3 months 1
- Reported prevalences for anxiety, depression, and PTSD at 12 months after discharge are 38%, 32%, and 18% respectively 1
- Severe axonal critical care neuropathies can result in prolonged periods of convalescence and incomplete recovery 1
- Impairment of one function may result in impairment of another; for example, depressive symptoms may lead to a reduction of physical health 1 or cognitive function 1 Management of these patients focuses on supportive care, particularly respiratory support, along with disease-specific treatments, and specialized care including careful ventilator management, prevention of complications, nutritional support, and early rehabilitation to prevent further muscle deconditioning. The guideline on multimodal rehabilitation for patients with post-intensive care syndrome 1 intends to promote clinical decisions and standards of care in order to improve the outcomes of adult patients at risk for developing or affected by symptoms of PICS.
From the Research
Definition of Neuromuscular Diseases in ICU
Neuromuscular diseases in the ICU refer to a group of disorders that affect the nervous and muscular systems, leading to weakness, paralysis, and respiratory failure. These conditions can be primary, such as Guillain-Barré syndrome and myasthenia gravis, or acquired in the ICU, such as critical illness myopathy and polyneuropathy 2, 3, 4, 5.
Types of Neuromuscular Diseases in ICU
Some common types of neuromuscular diseases encountered in the ICU include:
- Guillain-Barré syndrome: an autoimmune disorder that causes ascending paralysis and can lead to respiratory failure 2, 5
- Myasthenia gravis: an autoimmune disorder that causes muscle weakness and fatigue 2, 5, 6
- Critical illness myopathy: a condition that causes muscle weakness and wasting in critically ill patients 4, 5
- Critical illness polyneuropathy: a condition that causes nerve damage and weakness in critically ill patients 4, 5
Clinical Management of Neuromuscular Diseases in ICU
The clinical management of neuromuscular diseases in the ICU requires a multidisciplinary approach, involving neurologists, intensivists, and other healthcare professionals. The goals of management include:
- Early diagnosis and treatment of the underlying condition 2, 3, 5
- Supportive care, such as mechanical ventilation and nutritional support 2, 4
- Prevention of complications, such as respiratory failure and dysautonomia 2, 5
- Rehabilitation and recovery from the underlying condition 3, 5
Treatment Options for Neuromuscular Diseases in ICU
Treatment options for neuromuscular diseases in the ICU include:
- Immunomodulatory therapies, such as intravenous immunoglobulins and plasma exchange 6
- Pharmacological therapies, such as corticosteroids and neuromuscular blocking agents 4, 6
- Newer immunotherapies, such as eculizumab and edaravone, which have shown promise in the treatment of certain neuromuscular disorders 6