105. ICU Acquired Weakness

ICU Acquired Weakness (ICUAW) represents a significant, often under-recognized complication of critical illness, characterized by generalized, symmetric muscle weakness that develops after the onset of systemic disease. This condition functions as an umbrella term for critical illness myopathy, polyneuropathy, and combined neuromyopathy, each presenting with distinct pathophysiological mechanisms, including selective myosin loss and axonal degeneration. Clinical evaluation requires a systematic, anatomical approach—moving from the central nervous system to the muscle—utilizing tools like the Medical Research Council Score (MRCSS) and handheld dynamometry to quantify impairment. Management strategies prioritize early physical mobilization, strict glycemic control within the 140–180 mg/dL range, and the judicious use of neuromuscular blockers and corticosteroids to mitigate risk. While electrophysiologic studies and muscle biopsies serve as diagnostic gold standards, clinical assessment remains the primary tool for guiding rehabilitation and long-term functional recovery in the intensive care unit.