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ICUAW - Coggle Diagram
ICUAW
Risk factors
Severe sepsis
Prolonged mechanical ventilation
Sedation
Muscle paralysis
Steroids
Hyperglycaemia
Differential
GBS
mysthenia gravis
Motor neuron disease
Spinal cord pathology
Rhabomyalysis
Infective causes eg botulism
Investigation
Bloods
ESR
CK
B12
Lumber puncture
Imaging
MRI
Head
Spine
Nerve conduction
CIM = normal
CIPN
decreased muscle reaction
EMG
small amplitudes and short durations
Biopsy
excludes demylination
Definition
Diagnosis of exclusion
Myopathy
Neuropathy
Mixed
Often facial sparing
Management
Prevention
Glucose control
Aviod steriods
Aviod NMBD
Sedation holds
REgular physiotherapy
Respiratory Wean
Criteria
A
leak test
Bronchoscope
B
min oxygentation
Fi02 <.4 PEEP <8
min support
PS <10
Adequate drive
Spont breathing
Ability to clear secretions
Comply with physiotherapy
C
Stable
Types
Simple 60%
SBT
Extubated after first trial
Difficult 30%
3 SBTs
7 days
Prolonged
Tracheostomy
Re-intubation rate <5-10% suggests to conservative approach
Stages
Pre weaning
Suspician
Predictors
Decrease ventilator support
NIV
Reintubation if required
Predictors
RSBI
Failure of SBT
Physiological
HR>20%
SBP >20%
Arrythmias
RR>50%
ABG
Clinical
Agitation/anxiety
Increased respiratory effort
Scoring
MRC
Three muscle groups each side
Graded 0-5
Score <48 suggests polyneuropathy