الفهرس 
Anatomical and physiological
MicroanatomyOnly 14 pages are availabe for public view
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Abstract
Survival among patients in the ICU has improved
dramatically over the past 20 years. The greatest burdens that
survivors of critical illness face are related to neuromuscular
dysfunction and neuropsychological maladjustment.
Patients who survive respiratory failure, circulatory
failure (e.g., in association with ARDS or sepsis , or both
seem to have these problems with the greatest frequency and
intensity. Indeed, in patients who require prolonged
mechanical ventilation, neuromuscular recovery is typically
prolonged and incomplete. Studies show that up to 65% of
such patients have functional limitations after discharge from
the hospital (3,4). Neuromuscular abnormalities may last for
many years in some patients.
Weakness acquired in the intensive care unit (ICU) is
caused by many different pathophysiological mechanisms.
Though it is tempting to categorize weakness after recovery
from critical illness as either myopathy or neuropathy, there
is evidence of overlap between these pathophysiological
processes . Critical illness myopathy occurs more frequently
than critical illness neuropathy, and it is associated with a
higher rate of recovery . Furthermore, although specific
polyneuropathies, myopathies, or both contribute to physical
dysfunction in critically ill patients, other variables, such as
drug effects (e.g., from the use of glucocorticoids or neuromuscular blocking agents , metabolic effects (e.g.,
hyperglycemia , joint contractures, and muscle wasting from
catabolism and physical inactivity also contribute to ICUacquired weakness.
Although some of the risk factors, such as sepsis,
cannot necessarily be prevented, aggressive treatment of such
conditions is important to minimize subsequent morbidity.
Other risk factors, such as severe hyperglycemia, can be
attenuated with the use of insulin therapy with careful
monitoring to avoid hypoglycemia. Early mobilization of
patients in the ICU, although not a traditional approach, has
become established as an evidence-based strategy to reduce
the deconditioning and dysfunction so commonly seen in
survivors of critical illness. For this strategy to be successful,
ongoing attention to minimizing the use of sedation is
important. In addition, care providers in the ICU must
acknowledge the importance of a multidisciplinary care
model to optimize the efficacy of early mobilization .