Les myopathies en réanimation

Among ICU patients, ventilated for more than 5 to 7 days, 25% will develop acquired muscle weakness with persisting sequelae, several months after hospital discharge. Risk factors include: hypoxemia, oxidative stress, hyperglycemia, inflammation, sepsis, hypercatabolism and immobilisation. Numerous studies have pointed out the value of early mobilisation to prevent intensive care-acquired weakness. These protocols are initiated earlier and earlier after patient's ICU admission. They are standardized, simple, and progressive protocols including seating position and passive mobilization; seating position on the border of the bed as soon as the patient rises his upper limb and standing up as soon as he rises his lower limb, sitting in armchair and then walking. Active muscle contraction requires the cessation of sedation. Although well tolerated by patients, early mobilization implies several members of the nursing staff simultaneously. However, it is demonstrated that it increases muscle strength and the ability of deambulating after hospital discharge. Early mobilization is an integral part of a global management of the patients including the optimization of sedation, improvement in confort, nutrition, prevention of mental distubances and non-invasive ventilation if possible.