Intensive Care Unit (ICU)-acquired weakness (ICUAW) is a serious complication of intensive care treatment, leading to severe muscle weakness and failure to wean. ICUAW is the clinical presentation of distinct underlying pathologies, namely Critical Illness Myopathy (CIM), Critical Illness Polyneuropathy (CIP), or a combination of both syndromes (CIM/CIP). CIM is the most common condition, developing first and predisposing the development of CIP. A clinical differentiation is not possible, but

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... ectrophysiological evaluations, even in unresponsive patients, can detect anomalies associated with these entities and predict ICUAW. Our analysis (Publication #1) demonstrated that an early differentiation is associated with outcome one year after discharge, in that patients with an isolated CIM were more likely to recover completely, in contrast to those with concurrent neuropathy. Hyperglycemia has often been described as a risk factor for the development of CIM. Nevertheless, guideline recommendations instruct us to accept a moderate hyperglycemia to reduce the occurrence of hypoglycemia- which is independently associated with higher mortality. The underlying issue is that glucose management in the ICU is primarily intermittent, and our inability to promptly identify dangerous glucose fluctuations has forced us to hazard the consequences of hyperglycemia, including higher rates of CIM. Continuous glucose monitoring systems are promising, as they would alert clinicians to dangerous glucose levels in real-time. The accuracy and reliability of such systems, however, are major prerequisites for their implementation in the ICU. An analysis (Publication #2) of such a device shows that their performance remains inadequate, and that currently they do not meet the necessary requirements to guarantee patient safety in the ICU. In addition to hypo- and hyperglycemia, glucose variability has emerged as a third relevant domain, having an independent association with ICU mortality. The mechanism has not been sufficiently explained, [...]