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To complete the circle of cross talks between calpain, caspase-3, and the UPP, a recent study showed that treatment of CMV rats with the proteasome inhibitor bortezomib partially protected the diaphragm against the development of weakness, most probably by indirect inhibition of caspase-3 [21].
The possibility of a "postpoliomyelitis syndrome" (6 ) (e.g., development of weakness in a previously affected limb years after recovery) is unknown and will require longer term assessment.
Basic physiotherapy assessment muscle testing done as part of regular intervention assessment using the Medical Research Council or Manual Muscle Test will detect any possible development of weakness without requirements for formal diagnosis and is accepted as configuration of critical illness polyneuromyopathy [ 77].
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Its anatomic integrity should be respected in surgical procedures or ulnar-sided wrist pain because of instability, limitation of forearm rotation and potential development of grip weakness may develop.
Our data identify new mechanisms for hyperglycemia induced diaphragm weakness, and potentially explain how poor glucose control might potentiate the development of diaphragm weakness and prolong the duration of mechanical ventilation during critical illness.
In summary, we found that mechanically ventilated MICU patients have severe diaphragm weakness, that the clinicians caring for these patients greatly underestimate the severity of diaphragm weakness present, and that infections are a major risk factor for the development of diaphragm weakness in this population.
We assessed diaphragm strength in mechanically ventilated medical ICU patients, correlated the development of diaphragm weakness with multiple clinical parameters, and examined the relationship between the level of diaphragm weakness and patient outcomes.
The main safety concern with the use of a NMBA is muscle weakness since several studies suggest that the long-term administration of NMBAs may be associated with the development of neuromuscular weakness in critically ill patients.
The development of muscle weakness is a frequent occurrence in ICU patients.
Conclusions: Serial MLT measurements significantly underestimate muscle wasting in critical illness and are not related to development of muscle weakness.
For instance, inhibition of the calpain activity preserves sarcomere structure and attenuated the development of muscle weakness in hindlimbs of mice after 14 days of suspension [27].
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Justyna Jupowicz-Kozak
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