Author(s): Aaron Charnay, MD, Gabrielle Nguyen, MDD
Originally published: September 20, 2014 Last updated: December 8, 2025
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Disease/Disorder

Definition

Intensive care unit acquired weakness (ICU-AW) is a spectrum of clinical conditions characterized by weakness due to variable forms of damage to muscles and the peripheral nervous system and includes critical illness polyneuropathy (CIP), critical illness myopathy (CIM) and the rarer, overlapping form, critical illness polyneuromyopathy (CIPNM).1 CIP is a symmetrical, predominantly distal axonal polyneuropathy that mainly affects limb and respiratory muscles, and rarely the facial muscles.2,3 CIP and CIM may be hard to distinguish, but differentiation when possible is important as studies have shown that CIP is associated with significantly worse outcomes compared with CIM.4

Etiology

The etiology of CIP is complex and likely multifactorial, although not fully defined amongst the adult or pediatric population. It is thought to be associated with abnormal vascular, metabolic, and electrical processes leading to ischemia, degeneration and axonal dysfunction. This is further described below in the pathophysiology section.2,5

Epidemiology including risk factors and primary prevention

CIP is rare in children, reported to affect 0.02% of pediatric intensive care unit (PICU) admissions, although this figure may be an underestimation due to underdiagnosis driven by inadequate diagnostic testing.5,6 Among critically ill pediatric patients with prolonged intensive care unit (ICU) courses, CIP is increasingly recognized as a significant clinical problem.8

Pediatric CIP has been highly associated with sepsis complicated with multiple organ dysfunction syndrome and invasive mechanical ventilation for more than 7 days. It is also associated with hyperglycemia, renal replacement therapy, organ transplantation, burns, immobility, female sex, and toxic drug effects such as corticosteroid, aminoglycosides, statins, and neuromuscular blocking agents, though more recent meta-analyses in large adult populations have found less significant impact of corticosteroids and neuromuscular blocking agents on CIP risk, likely due to variable dose and duration of treatment in available studies.7 Risk factors that distinguish pediatric CIP patients from adults include asthma and use of extracorporeal life support.5,9,10

The primary prevention of CIP consists of treating the underlying disease, sepsis, multiorgan failure and electrolyte and metabolic imbalances with aggressive control of hyperglycemia, early mobilization, nutritional supplementation, and antioxidant therapy. Intensive insulin therapy with goal glucose between 80 and 110 mg/day has been shown to reduce the incidence of CIP and/or CIM from 51 to 39% in ICU medical patients, but great care must be taken to avoid hypoglycemia.2,8

Patho-anatomy/physiology

The pathophysiological changes that lead to axonal degeneration of CIP remain unclear. Pioneers in myoneuropathy proposed an interaction between microcirculatory changes, metabolic alterations, potentially reversible membrane channelopathies and a flush of pro-inflammatory cytokines. It is thought that microcirculation, commonly caused by hypovolemia, hyperglycemia or hypoalbuminemia, leads to increased vascular permeability and increased local cytokine production.2,8,11

Skin biopsies can be used to quantify intraepidermal nerve fiber density (IENFD) and corneal confocal microscopy (CCM) although neither have been shown to add clinical or prognostic value.11 Muscle biopsies may show acute denervation with atrophy of type 1 and type 2 fibers in muscles and axonal degeneration in nerves.3

Disease progression including natural history, disease phases or stages, disease trajectory (clinical features and presentation over time)

CIP typically appears within the first 10 days of ICU admission. It is more prevalent in those requiring mechanical ventilation and leads to difficulty weaning mechanical ventilation.11 Recovery is spontaneous but variable and can range from full recovery to persistent weakness or death. It is suggested that recovery from weakness after CIP is delayed as compared to CIM, often for several months with some with having persistent symptoms at 1 year.1

ICU-AW overall is associated with longer requirement of mechanical ventilation, longer hospitalization, increased mortality, decreased independence and increased cost.11 Approximately 70% of people with ICUAW are able to achieve a good recovery defined by a Medical Research Council (MRC) grade of 4/5 in all muscles.1

Specific secondary or associated conditions and complications

Prolonged immobility from profound weakness is also associated with compression neuropathies, muscle atrophy and joint contractures. It is then important to identify the presence of ICU-AW, including CIP, in comatose patients to prevent overly pessimistic prognostication resulting in inappropriate withdrawal of care. PICU admissions are associated with functional and cognitive impairments that may influence normal development, school performance and social interactions. Additional factors that may contribute to these sequelae in combination with ICU-AW are PICU complications from procedures and continued underlying illness.12

In patients with COVID-19 as compared to other patients with ICU-AW, there is a predominance of CIP as opposed to CIM in the non-COVID groups.13,14 In one study, there is a male predominance as compared to female predominance in non-COVID ICU-AW, though further research is required to fully characterize these patterns.13 Presentation and neurophysiologic parameters remain the same. This may be associated with the prolonged mechanical ventilation and use of neuromuscular blocking agents in COVID-19 patients. Fortunately, patients with COVID-19 related CIP appear to have superior functional outcomes than those with other etiologies.15 Nonetheless, CIP should remain in the differential diagnosis of ICU admitted COVID-19 patients with weakness as there are important implications on prognosis.13-15

Essentials of Assessment

History

A thorough functional history including premorbid functioning in addition to current functioning, taking into consideration the effect of sedative medication and respiratory deficits, can be useful in differentiating between CIM, CIP, and CIPNM. Special consideration should be given when critically ill children are not making proper progress in their recovery, placing them at increased risk for developing CIP.16

Physical examination

CIP typically involves symmetric, flaccid limb weakness with sparing of facial and ocular muscles. Muscle stretch reflexes are decreased or absent. Pain, temperature, vibration, or proprioception may also be absent or reduced. The diaphragm is commonly involved, which has important consequences for ventilator weaning and overall respiratory health.2

Functional assessment

It may be difficult to assess a child’s functional abilities if they have profound weakness, difficulty understanding the commands given during testing, or low premorbid functional skills. Manual muscle testing (MMT) can be done with children 4 years of age and older; for younger children, observation and evaluation of movement are effective.17 It is important to note that MMT was designed to quantify muscle strength and not function.1 According to a recent study, a simplified CIP criteria including strength testing with Medical Research Council (MRC) sum score <48 (on testing of six bilateral muscle groups including shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, ankle dorsiflexion) and tibial motor and sural sensory nerves amplitudes <80% of the lower limit of normal and was most predictive of clinical outcomes. Implementing these simplified criteria may allow early identification of CIP in the ICU, enabling prompt intervention for patients with an unfavorable prognosis.18

Laboratory studies

Serum creatine kinase is usually normal in CIP unless severe muscle necrosis is present. Elevation in plasma neurofilament, a biomarker of axonal injury, may be seen. Muscle biopsy is well known to distinguish between CIP and CIM; however, it is invasive and increases the risk of bleeding of ICU patients.19 Specific blood-based inflammatory markers of interest have been studied but have not been found to be effective in differentiating ICU-AW due to CIP or CIN 20

Supplemental assessment tools

Electrodiagnostic (EDX) testing, including nerve conduction studies (NCS) and needle electromyography (EMG) is the most helpful in definitive diagnosis, distinguishing CIP from CIM and other neuromuscular etiologies of weakness. Relative to other neuromuscular conditions, testing in critical illness neuromyopathy generally has excellent electrodiagnostic correlation since abnormalities are predominately found on NCS and EMG as opposed to late responses like F-waves, repetitive nerve stimulation, or single fiber EMG which are all generally more difficult to obtain in the ICU setting.

Typical EDX findings in CIP include reduced sensory nerve action potential (SNAP) amplitudes and neurogenic changes on EMG (large amplitude, polyphasic motor units) while CIM more often shows markedly reduced compound motor action potential (CMAP) amplitudes and myopathic changes on EMG (small amplitude, short duration motor units). Abnormal spontaneous activity with fibrillation potentials and/or positive sharps waves is often found, and depending on the degree of immobility, may be the only finding on EMG if unable to obtain voluntary activity.21

F wave latencies are typically normal and no associated decrement on repetitive nerve stimulation. Conduction block is not typically a feature, and if present should prompt further investigation into nerve entrapment, especially in thin patients. While EMG is the best way to diagnose CIP, the ICU environment introduces technical challenges including electrical interference, hypothermia, peripheral edema, or limited patient involvement.21

Neuroimaging may be obtained in comatose patients to rule out abnormality within the neuroaxis. A standardized ultrasound algorithm, consisting of measurement and scoring of 12 nerve cross-sectional areas on a patient, can serve as a fast bedside test for the presence of neuropathy in ICU-AW. Nerve ultrasonography reliably detects neuropathy in ICU-AW, although cannot differentiate between sensory neuropathy and CIP.22

Early predictions of outcomes

Development of ICU-AW is a most closely associated with prolonged ICU stay and duration of mechanical ventilation.23. Of children who develop ICU-AW, about 25% have persistent symptoms upon discharge from ICU which has been found to be an independent risk factor for decreased health related quality of life.24

Amongst those with ICU-AW, absence or 25% reduction in CMAP and SNAP amplitudes from baseline is considered a predictor of long-term dysfunction.  Presence of CIP also tends to have poorer prognosis compared to CIM alone.16

Ultrasound is being used more frequently to aid prediction of outcome including use of lung ultrasound as a predictor of difficulty weaning off ventilator25 or early ultrasonographic recognition of quadricep muscle wasting during PICU stay as a predictor of functional outcome.26

Environmental

Identifying the anticipated home setting at discharge is necessary to determine services and equipment needs. Similarly, appropriate provisions for school attendance may be required, including those related to the school architecture, such as wheelchair ramps and accessible bathroom, and school services such as provision of an aide or scribe and extra time for assignments, available.

Social role and social support system

Critical illness has a reaching effect on the entire family unit. Up to 33% of parents develop acute stress disorder, 84% report post-traumatic stress symptoms, up to 50% with anxiety and 15-30% have depression. Siblings are similarly impacted. The Pediatric Medical Traumatic Stress model supports psychological intervention in the early part of a family’s experience with goals to include mobilizing coping resources, normalizing reactions, and providing relevant information. Families should be educated on the various necessary adjustments anticipated to care for a child after CIP which may include constant care and physical assistance, use of durable medical equipment and the associated financial burden.12

Professional issues

Although children with CIP can initially present with severe weakness and inability to communicate, it is important to address rehabilitation management and strategies to prevent the complications of immobility. With proper attention to these issues, many patients with CIP will have the potential for significant recovery and a good quality of life.1,12

Rehabilitation Management and Treatments

At different disease stages

CIP is best addressed with a multimodal approach with emphasis on swift control of the underlying injury, early discontinuation of mechanical ventilation and early mobility.11 Various interventions and medications have been utilized to treat CIP, but a standardized treatment has not been established.27

Acute setting:   Early mobilization as early as within the first three days of PICU admission can help mitigate physical impairments as demonstrated by the PICU UP! initiative.28 which incorporated daily planning of mobilization goals by the multidisciplinary team. These included range-of-motion exercises, sitting, transfer to a chair, orthostasis, ambulation and play. In patients undergoing invasive mechanical ventilation, only range-of-motion exercises were considered.29

The most commonly reported barriers to early mobilization after PICU Up! Initiative implementation was availability of appropriate equipment (primarily age-appropriate seating devices and positioning materials).30 AI-assisted robotic mobilization systems are being studied in adults to address the barrier of limited staffing in order to enhance rehabilitation for mechanically ventilated patients in the ROBEM-I pilot study.31

Subacute setting: Once weaned off ventilator support, revaluation to determine the appropriate level of ongoing rehabilitation is warranted. This may include ongoing acute therapies within acute hospitalization, admission to an inpatient rehabilitation unit (IRU) for a more intensive therapies, or discharge home with an outpatient therapy program. Of note, early mobilization in ICU has demonstrated improved functional Wee-FIM scores on admission to IRU.32

Chronic/stable: Majority of pediatric patients with ICU-AW can continue with persistent upper and lower extremity weakness months to years after discharge.5 In order to achieve optimal results, physical medicine and rehabilitation (PM&R) physicians should be involved throughout the recovery phase. to determine whether further therapy and appropriate rehabilitation equipment are needed and address the long-term effects of diminished mobility. It is imperative to include longitudinal assessments during and after a PICU stay, especially for children at a higher risk of poor functional outcome.33

Coordination of care

Early mobilization and management of children with ICU-AW requires a strong interprofessional collaboration – ideally among critical care medicine, consultant medical services, PM&R, respiratory therapy, physical therapy, occupational therapy, nursing, social worker, care management, and the patient’s family.  

However, despite the recognized benefits of early mobilization, several barriers remain. PICU staff may prioritize patient comfort to minimize pain, particularly in mechanically ventilated children. Children themselves may be reluctant to participate in rehabilitation activities because of discomfort or fear, while families often express understandable concern about the perceived risks of mobilization.

Thus, successful implementation of early mobilization depends on many factors such as individualized assessments and goal setting through a collaborative interdisciplinary and family centered approach. Mobility goals and physical activities should be tailored to each child’s age, medical condition, premorbid function, strength, endurance, and developmental level.34

A recent study examining the knowledge, attitudes, and practices of PICU medical staff regarding ICU-AW found that clinicians with less than three years of experience of junior nurses scored significantly lower than their more experienced counterparts. These findings highlight the importance of incorporating ICU-AW education into staff training programs and providing opportunities for continued learning—such as external workshops, case discussions, and professional conferences—to strengthen the teams confidence and competence and early mobilization practices.35

Patient & family education

In the ICU early stages, families and medical staff are understandably focused on medical care and the potential for life-threatening complications. However, family members should also be educated about early mobilization and the concept of a rehabilitation team. This can happen via a consultation with PM&R or therapies at the time of the patient’s medical stabilization, or earlier if the care team considers it appropriate.

Programs such as the PICU Up! Initiative has demonstrated that structured early mobility efforts can be well received by families and hospital staff to improved team dynamics. Patients and family members appear enthusiastic about mobility efforts, leading to an increase in staff support.36

Emerging/unique interventions

For patients requiring more long-term therapy intervention, functional outcome measures typically used in the pediatric rehabilitation setting can be used to document functional changes over time (WeeFIM, Pediatric Evaluation of Disability Inventory, Gross Motor Function Measure). Early predictive models using machine-based learning with neural networks are being developed to aid in preventive strategies.23

Translation into practice: practice “pearls”/performance improvement in practice (PIPs)/changes in clinical practice behaviors and skills

  • Consider the presence of ICU-AW in children with prolonged ICU stay and require mechanical ventilation. A high index of suspicion is needed, as early diagnosis may be difficult, especially when the patient is still receiving sedation and/or paralytic drugs.
  • When ICU-AW is suspected, assess muscle strength, if possible. MRC < 48 suggests the presence of ICU-AW. If physical examination is unreliable, obtain an electrodiagnostic study. Changes can be seen within 24 to 48 hours after onset of this condition and can precede clinic findings.11
  • NCS characteristics typical in CIM include markedly diminished CMAP amplitudes but SNAPs are spared while CIP typically finds reduced or absent SNAP amplitudes. Spontaneous potentials may be the only EMG finding if weakness prevents voluntary motor unit activation.21
  • Although muscle biopsy may be helpful in determining the degree of CIM versus CIP, there is not a consensus on routinely obtaining biopsies in children.
  • Early mobility is a consistent recommendation in the literature for patients with ICU-AW.

Cutting Edge/Emerging and Unique Concepts and Practice

Direct muscle stimulation can help differentiate the degree of CIP from CIM. This technique is minimally invasive and can be done in children.2

Early mobilization while the patient is still on ventilator support is possible with coordination of team members to reduce sedation and monitor respiratory status for adjustments to the ventilator.28-30

Serial electrodiagnostic evaluation of the common peroneal nerve for reduction in CMAP may be helpful in the early diagnosis of ICU-AW in select populations.17

The development of a standardized practice algorithm may promote early detection and treatment of patients with CIP. This will hopefully result in reductions in previously discussed complications.

Recent work supports nutritional strategies (e.g. avoiding early supplemental parenteral nutrition) to improve long term physical function.39

Gaps in the Evidence-Based Knowledge

Pediatric ICU patients may have higher rates of CIP than studies indicate. A high index of suspicion is needed, as early diagnosis may be difficult, especially when the patient is still receiving sedation or paralytic drugs. This is especially true for patients who are making progress since this diagnosis is less likely to be entertained under such circumstances.

In the pediatric population, there are no interventions specific to CIP with measures of long-term outcomes leading to emphasis on prevention and prophylaxis measures. Most of the studies to date have been conducted at only one center with a small number of participants making generalizations difficult.2 COVID-19 related CIP is recognized though incompletely understood with more studies needed to describe clinical and neurophysiological findings in COVID patients.13,38

References

  1. Intiso D, Centra AM, Bartolo M, Gatta MT, Gravina M, Di Rienzo F. Recovery and long term functional outcome in people with critical illness polyneuropathy and myopathy: a scoping review. BMC Neurol. 2022;22(1):50.
  2. Tankisi H, de Carvalho M, Z’Graggen WJ. Critical Illness Neuropathy. J Clin Neurophysiol. 2020;37(3):205-7.
  3. Latronico N, Candiani A. Predominant involvement of motor fibres in patients with critical illness polyneuropathy. Br J Anaesth. 1997;79(4):547-8.
  4. Cheung K, Rathbone A, Melanson M, Trier J, Ritsma BR, Allen MD. Pathophysiology and management of critical illness polyneuropathy and myopathy. J Appl Physiol (1985). 2021;130(5):1479-89.
  5. Plaut T, Weiss L. Electrodiagnostic Evaluation Of Critical Illness Neuropathy.  StatPearls. Treasure Island (FL)2022.
  6. Wilmshurst JM, Ouvrier RA, Ryan MM. Peripheral nerve disease secondary to systemic conditions in children. Ther Adv Neurol Disord. 2019;12:1756286419866367.
  7. Yang Z, Wang, Xiaohui, Wang, Faying, Peng, Zeyu, Fan, Yuying. A systematic review and meta-analysis of risk factors for intensive care unit acquired weakness. Medicine 2022; 101(43):p e31405.
  8. Thabet Mahmoud A, Tawfik MAM, Abd El Naby SA, Abo El Fotoh WMM, Saleh NY, Abd El Hady NMS. Neurophysiological study of critical illness polyneuropathy and myopathy in mechanically ventilated children; additional aspects in paediatric critical illness comorbidities. Eur J Neurol. 2018;25(7):991-e76.
  9. Sunnetci Silistre E, Erbas O. The Ameliorative Effects of Ascorbic Acid on Critical Illness Polyneuropathy in Rodent Sepsis Model. J Pediatr Intensive Care. 2020;9(4):265-70.
  10. Harnisch LO, Riech S, Mueller M, Gramueller V, Quintel M, Moerer O. Longtime Neurologic Outcome of Extracorporeal Membrane Oxygenation and Non Extracorporeal Membrane Oxygenation Acute Respiratory Distress Syndrome Survivors. J Clin Med. 2019;8(7).
  11. Garcia-Martinez MA, Montejo Gonzalez JC, Garcia-de-Lorenzo YMA, Teijeira S. Muscle weakness: Understanding the principles of myopathy and neuropathy in the critically ill patient and the management options. Clin Nutr. 2020;39(5):1331-44.
  12. Watson RS, Choong K, Colville G, Crow S, Dervan LA, Hopkins RO, et al. Life after Critical Illness in Children-Toward an Understanding of Pediatric Post-intensive Care Syndrome. J Pediatr. 2018;198:16-24.
  13. Bocci T, Campiglio L, Zardoni M, Botta S, Coppola S, Groppo E, et al. Critical illness neuropathy in severe COVID-19: a case series. Neurol Sci. 2021;42(12):4893-8.
  14. Frithiof R, Rostami E, Kumlien E, Virhammar J, Fallmar D, Hultstrom M, et al. Critical illness polyneuropathy, myopathy and neuronal biomarkers in COVID-19 patients: A prospective study. Clin Neurophysiol. 2021;132(7):1733-40.
  15. Klein M, Einhäupl B, Grill E, Drunin G, Schmidt S, Cordes C, Egger M, Jurgen Gdynia H, Gorsler A, Gotze D, Dieter Rollnik J, Justinus Rosenfelder M, Walther E, Wertheimer D, Wimmer C, Young P, Jahn K, Bender A. Differences in functional outcome of COVID-19 and non-COVID-19 patients with critical illness polyneuropathy/ myopathy: a multicenter cohort study. J Neurol. 2025;272,197
  16. Shepherd S, Batra A, Lerner DP. Review of Critical Illness Myopathy and Neuropathy. Neurohospitalist. 2017;7(1):41-8.
  17. Kasinathan A, Sharawat IK, Singhi P, Jayashree M, Sahu JK, Sankhyan N. Intensive Care Unit-Acquired Weakness in Children: A Prospective Observational Study Using Simplified Serial Electrophysiological Testing (PEDCIMP Study). Neurocrit Care. 2021;34(3):927-34.
  18. Jung C, Choi NJ, Kim WJ, Chun YM, Lee HJ, Kim TH, et al. Simplified Diagnosis of Critical Illness Polyneuropathy in Patients with Prolonged Mechanical Ventilation: A Prospective Observational Cohort Study. J Clin Med. 2020;9(12).
  19. Marrero H, Stalberg EV, Cooray G, Corpeno Kalamgi R, Hedstrom Y, Bellander BM, et al. Neurogenic vs. Myogenic Origin of Acquired Muscle Paralysis in Intensive Care Unit (ICU) Patients: Evaluation of Different Diagnostic Methods. Diagnostics (Basel). 2020;10(11).
  20. Klawitter F, Laukien F, Fischer D.-C., Rahn A, Porath K, Danckert L, Bajorat R, Walter U, Patejdl R, Ehler J. Longitudinal Assessment of Blood-Based Inflammatory, Neuromuscular, and Neurovascular Biomarker Profiles in Intensive Care Unit-Acquired Weakness: A Prospective Single-Center Cohort Study. Neurocritical Care. 2025;42(1), 118–130
  21. Nastasi L, Aldrees A, Motan D, Azam S, Pitt M, Cooray G, Deeb J. Electrodiagnostic characteristics of neuromuscular disease in paediatric intensive care. Clin Neurophysiol. 2025 Jun;174:123-130.
  22. Gruber L, Loizides A, Gruber H, Skalla E, Haushammer S, Horlings C, et al. Differentiation of Critical Illness Myopathy and Critical Illness Neuropathy Using Nerve Ultrasonography. J Clin Neurophysiol. 2022.
  23. Wang L, Long DY. Significant risk factors for intensive care unit-acquired weakness: A processing strategy based on repeated machine learning. World J Clin Cases 2024; 12(7): 1235-1242
  24. Min Ding, Chunfeng Yang, Yanling Qin, Yumei Li. Risk factors and 6-month outcomes of paediatric intensive care unit–acquired weakness. Australian Critical Care. Volume 38, Issue 5, 2025, 101294
  25. Hao X, Duan H, Li Q, Wang D, Yin X, Di Z, Du S. Value of combining lung ultrasound score with oxygenation and functional indices in determining weaning timing for critically ill pediatric patients. BMC Med Imaging. 2025 Jan 16;25(1):19
  26. Valla FV, Young DK, Rabilloud M, Periasami U, John M, Baudin F, Vuillerot C, Portefaix A, White D, Ridout JA, Meyer Bénédicte R, Le Roux G, Javouhey E, Pathan N. Thigh Ultrasound Monitoring Identifies Decreases in Quadriceps Femoris Thickness as a Frequent Observation in Critically Ill Children: Erratum. Pediatr Crit Care Med. 2025 Mar 1;26(3):e421. 
  27. Friedrich O, Reid MB, Van den Berghe G, Vanhorebeek I, Hermans G, Rich MM, and Larsson L. The Sick and the Weak: Neuropathies/Myopathies in the Critically Ill. Physiological Reviews 2015 95:3,1025-1109
  28. Ames SG, Alessi LJ, Chrisman M, Stanger M, Corboy D, Sinha A, et al. Development and Implementation of Pediatric ICU-based Mobility Guidelines: A Quality Improvement Initiative. Pediatr Qual Saf. 2021;6(3):e414.
  29. Piva TC, Ferrari RS, Schaan CW. Early mobilization protocols for critically ill pediatric patients: systematic review. Rev Bras Ter Intensiva. 2019;31(2):248-57.
  30. Wieczorek B, Ascenzi J, Kim Y, Lenker H, Potter C, Shata NJ, et al. PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill Children. Pediatr Crit Care Med. 2016;17(12):e559-e66.
  31. Lorenz M, Langer N, Kloss P, Maechler M, Bald A, Warner L, Fuest K, Weiß B, Schaller SJ. ROBotic-assisted Early Mobilization in ventilated surgical critically ill patients (ROBEM-I)-A randomized, controlled, outcome-assessor-blinded pilot study. Anaesthesia, Critical Care & Pain Medicine. 2025;44(4);101549.
  32. Biagioni J, Easley T, DeAlmeida ML, Vova J, Fujimoto AB, Graessle S, Nelson J. Early mobilization in a pediatric intensive care unit and WeeFIM scores at rehabilitation: A retrospective study. J Pediatr Rehabil Med. 2023;16(3):507-515.
  33. Bossen D, de Boer RM, Knoester H, Maaskant JM, van der Schaaf M, Alsem MW, et al. Physical Functioning After Admission to the PICU: A Scoping Review. Crit Care Explor. 2021;3(6):e0462.
  34. Morrow BM. Building a culture of early mobilization in the pediatric intensive care unit-a nuts and bolts approach. Transl Pediatr. 2021;10(10):2845-57.
  35. Huang D, Zhang W, Peng W, Fan Y, He X, Xing R, Yan X, Zhou S, Peng Y, Luo W. Knowledge, attitudes and practices regarding children with ICU-acquired weakness in pediatric intensive care unit among chinese medical staff: a cross-sectional survey. BMC Nurs. 2023;22(1):162.
  36. Patel RV, Redivo J, Nelliot A, Eakin MN, Wieczorek B, Quinn J, et al. Early Mobilization in a PICU: A Qualitative Sustainability Analysis of PICU Up! Pediatr Crit Care Med. 2021;22(4):e233-e42.
  37. Vanhorebeek I, Jacobs A, Mebis L, Dulfer K, Eveleens R, Van Cleemput H, Wouters PJ, Verlinden I, Joosten K, Verbruggen S, Van den Berghe G. Impact of critical illness and withholding of early parenteral nutrition in the pediatric intensive care unit on long-term physical performance of children: a 4-year follow-up of the PEPaNIC randomized controlled trial. Crit Care. 2022;26(1):133.
  38. Cabanes-Martinez L, Villadoniga M, Gonzalez-Rodriguez L, Araque L, Diaz-Cid A, Ruz-Caracuel I, et al. Neuromuscular involvement in COVID-19 critically ill patients. Clin Neurophysiol. 2020;131(12):2809-16

Original Version of the Topic

Douglas G. Kinnett, MD. Pediatric Critical Illness Neuropathy. 9/20/2014.

Previous Revision(s) of the Topic

Marina Ma, MD, Douglas G. Kinnett, MD. Pediatric Critical Illness Neuropathy. 5/29/2018.

Robert Rinaldi, MD, Robert Emeh, Kayla Williams, MD. Pediatric Critical Illness Neuropathy. 11/30/2022

Author Disclosure

Aaron Charnay, MD
Nothing to Disclose

Gabrielle Nguyen, MD
Nothing to Disclose