Traditional (indirect) techniques, such as electromyography and nerve conduction velocity measurement, do not reliably predict intensive care unit-acquired muscle weakness and its clinical consequences. Therefore, quantitative assessment of skeletal muscle force is important for diagnosis of intensive care unit-acquired motor dysfunction. There are a number of ways for assessing objectively muscle strength, which can be categorized as techniques that quantify maximum voluntary contraction force and those that assess evoked (stimulated) muscle force. Important factors that limit the repetitive evaluation of maximum voluntary contraction force in intensive care unit patients are learning effects, pain during muscular contraction, and alteration of consciousness.
The selection of the appropriate muscle is crucial for making adequate predictions of a patient’s outcome. The upper airway dilators are much more susceptible to a decrease in muscle strength than the diaphragm, and impairment of upper airway patency is a key mechanism of extubation failure in intensive care unit patients. Data suggest that the adductor pollicis muscle is an appropriate reference muscle to predict weakness of muscles that are typically affected by intensive care unit-acquired weakness, i.e., upper airway as well as extremity muscles. Stimulated (evoked) force of skeletal muscles, such as the adductor pollicis, can be assessed repetitively, independent of brain function, even in heavily sedated patients during high acuity of their disease.
From the Department of Anesthesia, Critical Care and Pain Medicine (EAB, JAM, EG, ME), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Shriners Hospital for Children (JAM), Boston, MA; Post Anesthesia Care Unit (EG), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Physical Medicine and Rehabilitation and Physiology (WRF), University of Puerto Rico School of Medicine Medical Sciences Campus, San Juan, Puerto Rico; and Klinik fuer Anaesthesiologie und Intensivmedizin (ME), Universitaetsklinikum Essen, Essen, Germany.
This study was supported, in part, by departmental sources.
The authors have not disclosed any potential conflict of interest.
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