Neuromuscular complications in the ICU: the spectrum of critical illness-related conditions causing muscular weakness and weaning failure.

Muscular weakness and atrophy in intensive care patients has long been attributed to a combination of immobilization and cataboly. More recently, it has become apparent that specific injuries to the peripheral nerve, the neuromuscular junction and the muscle are more likely causes of weakness in these patients. Clinically, delayed weaning from the ventilator and prolonged neurologic rehabilitation are the most important consequences. Detailed electrodiagnostic examination is necessary for accurate diagnosis. In selected patients, a combined muscle and nerve biopsy is helpful. In this review, I describe the current knowledge of neuromuscular complications in patients with long-term treatment in the intensive care unit.