Acute and Critical Care

Review Article

Surgery
Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review: Hanan Elkalawy, Pavan Sekhar, Wael Abosena; Acute Crit Care. 2023;38(4):409-424. Published online November 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00703

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Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.

Citations

Citations to this article as recorded by

Nursing-based precision assessment of nutrition and muscle status without ultrasound: a prospective observational study in mechanically ventilated neurosurgical patients
Chenliang Pan, Dingding Xu, Zixin Wang, Jia Wen, Lili Ma, Yajuan Zhang
Frontiers in Medicine.2026;[Epub] CrossRef
Risk Factors and Prediction Model for ICU-Acquired Weakness in Severe Acute Pancreatitis: A Retrospective Cohort Study
Lu Li, Jing Liu, HuanQi Ji, Chao Wu, Yang Li, Qian Yang, HongJuan Lang
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef
Effect of early intensive physical therapy on NLRP3 inflammasome activation and muscle atrophy in critical illness myopathy (PT-NLRP3-CIM): a two-centre randomized open-label study protocol
Óscar Arellano-Pérez, Luan Americo-Da-Silva, Denisse Valladares-Ide, Lilian Jara, Iván Hernández-Flores, Federico Heredia-Wendt, Camila Pino-Figueroa, Felipe Castillo-Merino, Sebastián Ugarte-Ubiergo, Margot Navarrete-García, Paola Llanos
Trials.2026;[Epub] CrossRef
Application of lower limb exoskeleton robots in elderly patients with ICU-acquired weakness: a prospective clinical study
Xing Jin, Xiu-rong Wang, Kui Wang, Meng-yi Ren, Kang Yang, Bo Chen, Daejung Yang, Zhao-xiang Meng
BMC Geriatrics.2026;[Epub] CrossRef
Mapping the research landscape and evolving hotspots of intensive care unit-acquired weakness: a dual-database bibliometric analysis
Xuehua He, Peiqi Liu, Xiaoyan Gong, Yiyu Zhuang, Xiangping Chen
Frontiers in Neurology.2026;[Epub] CrossRef
Knowledge, practices, and barriers to early mobilization of critical care nurses in three hospitals in Sabah, Malaysia: A multicentre cross-sectional study
Saniah Ajui, Boon Tat Yeap, Deena Clare Thomas
MethodsX.2026; 16: 103901. CrossRef
Implementation and Results of On-Table Extubation Following Hypothermic Circulatory Arrest: Early Experience and Outcomes
Justin W. Walker, Nicholas D’Alonzo, Cooper Grove, Abdulrhman S. Elnaggar, Shayne Michael Roberts
Seminars in Cardiothoracic and Vascular Anesthesia.2026;[Epub] CrossRef
Advancing Nutritional Care Through Bioelectrical Impedance Analysis in Critical Patients
Ana Maria Dumitriu, Cristian Cobilinschi, Bogdan Dumitriu, Sebastian Vâlcea, Raluca Ungureanu, Angela Popa, Rǎzvan Ene, Radu Țincu, Ioana Marina Grințescu, Liliana Mirea
Nutrients.2025; 17(3): 380. CrossRef
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Chen Xin, Yubiao Gai, Lili Wei, Yanqiu Wang, Yuhong Luo, Binru Han
International Journal of Nursing Studies Advances.2025; 8: 100301. CrossRef
Relação entre a perda de massa magra, força muscular e capacidade funcional de pacientes críticos vítimas de trauma
Tamine Vitória Pereira Moraes, Renato Valduga , Priscilla Flávia de Melo Fernandes, Guilherme Duprat Ceniccola
Health Residencies Journal.2025;[Epub] CrossRef
Development and validation of machine learning-based risk prediction models for ICU-acquired weakness: a prospective cohort study
Yimei Zhang, Yu Wang, Jingran Yang, Qinglan Li, Min Zhou, Jiafei Lu, Qiulan Hu, Fang Ma
European Journal of Medical Research.2025;[Epub] CrossRef
Diagnostic Innovations to Combat Antibiotic Resistance in Critical Care: Tools for Targeted Therapy and Stewardship
Ahmed D. Alatawi, Helal F. Hetta, Mostafa A. Sayed Ali, Yasmin N. Ramadan, Amirah B. Alaqyli, Wareef K. Alansari, Nada H. Aldhaheri, Talidah A. Bin Selim, Shahad A. Merdad, Maram O. Alharbi, Wejdan Alhumaidi Hmdan Alatawi, Abdelazeem M. Algammal
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Early skeletal muscle loss and clinical outcomes in critically ill patients in the medical intensive care unit: A retrospective cohort study
Soyun Kim, Da Hyun Kang, Dukki Kim, Soyoung Ahn, Mi Ra Lee, Song I Lee, Masoud Rahmati
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The role of bioimpedance in determining protein intake after ICU care
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Clinical Nutrition Open Science.2025; 64: 230. CrossRef
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Yanyang Zhang, Jinfu Ma, Qing Zhao, Hui Liu
The Journal of Critical Care Medicine.2024; 10(2): 130. CrossRef
Advancing critical care recovery: The pivotal role of machine learning in early detection of intensive care unit-acquired weakness
Georges Khattar, Elie Bou Sanayeh
World Journal of Clinical Cases.2024; 12(21): 4455. CrossRef
Construction and evaluation of acquired weakness nomogram model in patients with mechanical ventilation in intensive care unit
Chen Lu, Jiang Wenjuan
DIGITAL HEALTH.2024;[Epub] CrossRef
A scoping review of preclinical intensive care unit-acquired weakness models
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Frontiers in Physiology.2024;[Epub] CrossRef

Case Report

Thoracic surgery
Aortic Dissection in a Survivor after Cardiopulmonary Resuscitation: Jeong-Sun Lee, Suk-Kyung Hong; Korean J Crit Care Med. 2017;32(2):218-222. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00416

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Abstract PDF

We describe a case of traumatic aortic dissection associated with cardiac compression in a patient with anaphylactic cardiac arrest who underwent cardiopulmonary resuscitation (CPR). A 54-year-old man who was scheduled to undergo surgery for gastric cancer went into cardiac arrest caused by an anaphylactic reaction to prophylactic antibiotics in the operating room. Veno-arterial extracorporeal membrane oxygenation (ECMO) was performed. CPR, including chest compressions, was performed for 35 min, and the patient was transferred to the intensive care unit (ICU) after spontaneous circulation returned. The patient received ECMO for 9 hours until confirmation of normal cardiac function on transthoracic echocardiography (TTE). Twenty days after cardiac arrest, an aortic dissection and fractures in the left fourth and fifth ribs due to chest compression were detected by abdominal computed tomography. The DeBakey type III aortic dissection extended from the distal arch of the thoracic aorta to the proximal level of the renal artery, involving the celiac trunk. It was considered an uncomplicated type B aortic dissection with no sign of malperfusion of the major vessels. This case demonstrates the potential traumatic injuries that can occur after CPR and encourages proper management of mechanical complications in cardiac arrest survivors.

Citations

Citations to this article as recorded by

Extracorporeal Life Support use during Severe Anaphylaxis: A Systematic Review and Pooled Analysis of Individual Patient Data
Eduardo Saadi Neto, Ronna L. Campbell, Autumn Brogan, Fernanda Bellolio, Aidan F. Mullan, Danielle Gerberi, Nguyen Ba Cuong, Alexander S. Finch
Journal of Cardiothoracic and Vascular Anesthesia.2026;[Epub] CrossRef
Blunt traumatic aortic dissection death by falling: an autopsy case report
Gentaro Yamasaki, Marie Sugimoto, Takeshi Kondo, Motonori Takahashi, Mai Morichika, Azumi Kuse, Kanako Nakagawa, Yasuhiro Ueno, Migiwa Asano
Forensic Science, Medicine and Pathology.2022; 19(3): 388. CrossRef
A Case of an Aortic Dissection After Mechanical Chest Compression by LUCAS
Karen Ho, David Kopriva, Payam Dehghani
JACC: Case Reports.2020; 2(12): 1984. CrossRef
Cardiac arrest after topical application of lidocaine during microneedling procedure: A rare case
Morteza Safi, Isa Khaheshi, Fatemeh Mottaghizadeh, Mohammadreza Tabary, Nasser Malekpour Alamdari
Dermatologic Therapy.2020;[Epub] CrossRef

Original Articles

Analysis of Kidney Computed Tomographic Findings in Patients with Acute Pyelonephritis and Septic Shock: Soonseong Kwon, Sangchan Jin, Wooik Choi, Sungjin Kim; Korean J Crit Care Med. 2013;28(4):272-279.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.272

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Abstract PDF: BACKGROUND
Clinical findings, medical history and laboratory findings in patients with acute pyelonephritis are insufficient to predict the occurrence of septic shock and to assess its severity and prognosis. Early imaging may not only aid in diagnosing acute pyelonephritis, but also help in assessing the risk factors associated with septic shock.
METHODS
In this retrospective study, we reviewed the medical records and collected the data of 200 patients from January to December, 2011. All patients were over 18 years old; showed symptoms of fever, chills, muscle pain and flank pain; demonstrated more than 10 white blood cells in urinalysis; and were diagnosed with acute pyelonephritis after computed tomography (CT) scan. Patients were classified into two groups: patients with septic shock (group 1) and patients without septic shock (group 2), and the clinical, laboratory and CT findings of the two groups were then compared.
RESULTS
Out of all 200 patients, there were 32 patients (16%) who had acute pyelonephritis with septic shock. The acute pyelonephritis with septic shock group (group 1) showed increased bacteremia compared with the other group (53.1% vs. 24.4%, p = 0.002). Laboratory findings showed that group 1 patients had higher serum creatinine (1.67 +/- 1.03 mg/dl vs. 1.14 +/- 0.98 mg/dl, p = 0.022) and hsCRP (8.36 +/- 5.29 mg/dl vs. 5.27 +/- 3.53 mg/dl, p = 0.000) than group 2 patients. The findings of kidney CT showed statistically significant differences in global renal enlargement (31.3% vs. 18.7%, p = 0.005), pelvicalyceal wall thickening (37.5% vs. 13.1%, p = 0.005) and poor excretion of contrast (25% vs. 2.4%, p = 0.000). The results of the logistic regression test showed that there were significant differences in bacteremia serum creatinine, C-reactive protein, pelvicalyceal wall thickening and poor excretion of contrast.
CONCLUSIONS
Computed tomography can predict the possibility of septic shock by identifying the range of renal lesions in patients with acute pyelonephritis. It can therefore allow initial aggressive treatment that can contribute to decreases in mortality and morbidity in patients with acute pyelonephritis.

Clinical Feature and Prognostic Factors of Emphysematous Pyelonephritis: Won Soek Yang, Won Young Kim, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Won Kim, Kyoung Soo Lim; Korean J Crit Care Med. 2012;27(2):89-93.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.89

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Abstract PDF

BACKGROUND
Emphysematous pyelonephritis (EPN) is a rare and potentially life-threatening condition that requires prompt evaluation and management. However, its clinical presentation and outcomes vary widely. This study was conducted to ascertain the clinical features and prognostic factors regarding EPN.
METHODS
All patients diagnosed with EPN radiologically and treated at the emergency department in the university-affiliated, tertiary-referral center, from January 1999 to December 2009 were evaluated. The patients' demographic and clinical characteristics, computed tomographic findings, treatment, and outcomes were analyzed retrospectively.
RESULTS
Overall 14 patients diagnosed with EPN were admitted. There were 12 females and 2 males. A history of diabetes was found in 12 (85.7%) patients and was the most common comorbidity. The chief complaint among patients was flank pain (42.9%). Severe sepsis or septic shock was noted in 10 (71.4%) patients. Thirteen cases had unilateral involvement and one case had bilateral involvement. More than half of patients had Escherichia.coli in culture. Mean serum levels of HbA1c, creatinine, C-reactive protein (CRP) were 9.4 +/- 2.7, 2.4 +/- 1.4 mg/dl, and 22.4 +/- 13.1 mg/dl. Eight (57.1%) patients received antibiotic treatment alone and four (28.6%) patients received the concurrent percutaneous drainage as well as antibiotics. Hospital mortality was 7.1%. A higher initial serum CRP level (20.3 vs. 49.8 mg/dl, p = 0.02) and HbA1c level (8.7 vs. 16.4, p = 0.01) was associated with hospital mortality.
CONCLUSIONS
Antibiotics alone provide a high success rate for the treatment of EPN. Higher serum CRP and HbA1c level was associated with a higher mortality rate in patients with EPN.

Citations

Citations to this article as recorded by

Analysis of Kidney Computed Tomographic Findings in Patients with Acute Pyelonephritis and Septic Shock
Soonseong Kwon, Sangchan Jin, Wooik Choi, Sungjin Kim
Korean Journal of Critical Care Medicine.2013; 28(4): 272. CrossRef

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