ICU-AW (ICU-Acquired Weakness) in prolonged on-ventilator patients is mainly caused by respiratory muscle weakness and neuromuscular disorder
Muscle weakness is a frequent problem in the intensive care unit (ICU). The weakness can be due to primary neuromuscualr disorders that trigger the need for intensive care. More often, however, muscle weakness develops as a secondary disorder while patients are being treated for the other-life-threatening conditions. This is called "ICU-Acquired Weakness" or ICU-AW. Clinically speaking, ICU-AW mainly affects limb and respiratory muscles strenght which in turn causes mucus removal efficency reduction due to a weak cough process. Also ICU-AW is one of the major cause of nosocomial infection for ventilated patient including Ventiator-Acquired Pnemonia (VAP). This, in effect, prolongs the ICU stay and difficult weaning from the ventilator itself.
Diaphragm (a main respiratory muscle) weakness is highly prevalent in critically ill patients. It may exist prior to ICU admission and may precipitate the need for mechanical ventilator, but it also frequently develops during the ICU stays. Severyal risk factors for diaphragm weakness have been identified, among them sepsis and mechanical ventilator play central roles. Critically illness-associated diaphragm weakness is consistently associated with poor outcomes including increase ICU mortality, difficult weaning, and prolonged duration on mechanical ventialtion as previously mentioned.
Early Rehabilitation Therapy (ERT) in ICU for ventilated patient can improve recovery and reduce weaning-off period; consequently, mitiagte VAP and ICU-AW problem
Regardless of the underlying pathology, prolonged ICU stay frequently involves sedation and immobilization. This is associated with musculoskeletal, pulmonary, cardiovascualr, immunological, endocrine, and metabolic complications. Musculoskeletal consequences are especially relevant and include muscle atrophy, decreased strength, reduced pretein synthesis, joint contractures, and bone density decrease. More often, ICU patients show critical illness-associated neuromuscular abnormalities. The complexity of ICU patient management is compounded if the underlying disease effects the Central Nervous System (CNS) and/ or Peripheral Nervous System (PNS).
In this respect, early rehabilitative inteventions are fundamental in reducing possible added neurological burden to a disease that already greatly affects pulmonary function. In addition, managing neuromuscular weakness would improve the efficiency of respiratory function, as respiratory muscle atrophy worsens lung function as seen in recent cases of COVID-19.
Respiratory Neuromuscular Electrical Stimulator (Respower) - an emerging approach to deeply stimulate the respiratory nerve (Phrenic) and muscle (Abs) in early rehabilitation therapy
For years, the method known as Neuro-Muscular Electrical Stimulator (NMES) has gain widely acceptance in ICU early therapy. Its major function is to stimultate the contraction and movement of weak respiratory muscles (diaphragm and abdominal) in an early stage of the ICU operation in order to improve respiratory function, strengthen a cough process to remove secretion in the lower respiratory tract, and shorten the weaning period; hence the reduction in morbidity and mortality rate during the ICU stay.
Respower is, the first of its kind, the only automated NMES device available for a therapist to perform respiratory neuromuscular training at the earliest stage as possible, given that the patient is in an unconcious stage with the ventilator. It can increase contractility and contraction speed of the diaphragm and abdominal, enhance fatique resistance, and increase respiratory muscle strength which in turn help weaning from the ventilator sooner than usual. It can also reduce lung hyperinflation of patients with COPD, increase expiratory flow rate, tidal volume, ventilation per minute; while reducing the respiratory rate.
Respower can be applied for an early rehabilitation in multiple clinical treatments including Chronic Obstructive Pulmonary Disease (COPD), Restrictive Pulmonary Disease, Pulmonary Arterial Hypertension, Lung Cancer, ICU-AW, Spinal Cord Surgery, Neuromuscular Disorder (NMD) which weakens the respiratory muscles,