Join Jim Devanney, a physiatrist transitioning to a role at the University Health Network, and Kalilah Pais, a third-year internal medicine resident passionate about critical care. They dive into the often-overlooked issue of ICU Acquired Weakness, detailing its clinical presentation and potential causes. A compelling case study reveals the significant challenges faced by a sepsis patient experiencing muscle weakness. The duo emphasizes the importance of systematic diagnosis and early intervention strategies to improve recovery in critical care settings.
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insights INSIGHT
Neuro-Anatomical ICU Weakness Approach
Use a neuro-anatomical approach from brain to muscle to assess ICU weakness.
This systematic method organizes potential causes from central to peripheral pathways.
volunteer_activism ADVICE
Clinical Features Guide Localization
Assess symmetry, pattern, sensory loss, and reflexes to localize weakness.
These clinical features help distinguish central from peripheral causes effectively.
insights INSIGHT
ICU Weakness Spectrum and Risks
ICU acquired weakness includes critical illness myopathy, neuropathy, and mixed forms.
Multiple modifiable and non-modifiable risk factors contribute, including immobility and hyperglycemia.
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Today we’re talking about a topic that is relevant for all critical care physicians but under-examined: ICU Acquired Weakness. We are joined by two excellent guests to walk through a case and discuss the diagnosis, pathophysiology, prevention, and treatment of ICU Acquired Weakness. Check out our associated infographics and key learning points below.
Meet Our Guests
Jim Devanney is a Physiatrist who just completed a neurocritical care fellowship at BIDMC. He is transitioning to a clinical associate position at University Health Network – University of Toronto where he will be working as a PM&R consultant within the ICU.
Kalaila Pais is a third year internal medicine resident at BIDMC, interested in pulmonary and critical care and medical education and is returning for her third Pulm PEEPs episode.
Key Learning Points
Definition & Clinical Presentation
ICU-AW refers to new-onset, generalized muscle weakness that arises during critical illness, not explained by other causes.It typically presents as:
Symmetric, proximal > distal weaknessRespiratory muscle involvementPreserved cranial nerve functionNo sensory deficits in myopathy (sensory loss points toward neuropathy)
Differential Diagnosis Using Neuroanatomical ApproachAn anatomical approach (central → peripheral) helps localize the etiology weakness
PulmPEEPs 
