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Related Experiment Video

Updated: Dec 22, 2025

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Intensive Care Unit-Acquired Weakness: Neuropathology.

Michael Swash1,2, Mamede de Carvalho2,3

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Intensive care unit-acquired weakness affects both nerve and muscle fibers, leading to axonal degeneration and muscle atrophy. Steroids, sepsis, and immobilization are key factors contributing to this debilitating condition.

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Area of Science:

  • Neurology
  • Pathology
  • Critical Care Medicine

Background:

  • Intensive care unit-acquired weakness (ICU-AW) frequently impacts peripheral nerve and muscle fibers.
  • Pathological changes include axonal degeneration in nerves and atrophy, particularly in type 2 muscle fibers, with potential for necrotizing myopathy.

Purpose of the Study:

  • To review the pathological mechanisms underlying peripheral nerve and muscle fiber involvement in ICU-AW.
  • To identify risk factors and diagnostic methods for ICU-AW.

Main Methods:

  • Literature review of evidence on peripheral nerve and muscle fiber pathology in ICU-AW.
  • Discussion of contributing factors such as steroids, sepsis, immobilization, hyperglycemia, hypoalbuminemia, and hypoperfusion.
  • Evaluation of diagnostic utility of nerve and muscle biopsies.

Main Results:

  • Peripheral nerve lesions show axonal degeneration without inflammation.
  • Muscle fibers exhibit atrophy and loss of thick filaments, with type 2 fibers predominantly affected. Acute necrotizing myopathy is also observed.
  • Steroids, immobilization, sepsis, hyperglycemia, hypoalbuminemia, and hypoperfusion are identified as risk factors for axonal and muscle injury.

Conclusions:

  • ICU-AW involves distinct pathological processes in peripheral nerves and muscles.
  • Understanding these mechanisms and risk factors is crucial for diagnosis and management.
  • While invasive, nerve and muscle biopsies can aid diagnosis in specific cases.