Acute Skeletal Muscle Wasting During Critical Illness

Acute skeletal muscle wasting during critical illness represents a common complication with important impact on short- and long-term outcomes. Muscle weakness can also impair respiratory, oropharyngeal, and abdominal muscles, with difficult to wean from mechanical ventilation and higher extubation failure rates. Patients surviving the acute phase of critical illness and discharged from the hospital can suffer from various degrees of weakness with a heterogeneous extent of muscle deficit and subsequent limitation in working activity. The pathophysiological mechanisms responsible of acute skeletal muscle wasting remain mostly unknown and no effective treatments are currently available. However, several preventive strategies may play a central role in potentially reducing the incidence of muscle wasting: minimizing the administration of sedative drugs and neuromuscular blocking agents, optimize nutritional support and glycemic control, early mobilization and rehabilitation, and reducing the dose and the duration of steroid treatment. In this chapter, we aimed to provide an overview of the current understanding of the pathophysiology of acute skeletal muscle wasting, to outline possible common risk factors and to describe the short and long-term outcome.