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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 . |