In a first cross-sectional pilot study in our hospital we found a point prevalence of 88 patients with defined diagnosis of CIM/CIP and ICU-acquired muscle weakness per month.16 Therefore, based on this pilot study it seems to be
realistically to reach the anticipated sample size in our cohort study within 3 years of recruitment. Study population Patients with ICU-acquired selleck muscle weakness and defined diagnosis of CIM/CIP will be recruited consecutively from the ICUs of our acute care, weaning and early rehabilitation centres of Klinik Bavaria Kreischa in Germany. Inclusion criteria Patient is chronic critical ill or has a contemporary history of chronic critical ill-defined as more than 21 days ICU-treatment including mechanical ventilation and at least 14 days further existing critical situation with the need for ICU-treatment;17 Defined diagnosis of CIM and CIP.18 19 The diagnosis of CIM/CIP will be confirmed by a neurologist. Therefore, clinical and neurophysiological data will be revealed. The procedure of diagnosis of CIP and CIM is described in detail elsewhere;20 Muscle weakness defined as a Medical Research Council (MRC) sum score of less than 48 points;1 More than 18 years old; Richmond Agitation Sedation Scale (RASS) score from −1 to 2;21 Written informed
consent of the patient or his legal guardian. Exclusion criteria Patients receiving palliative care. Comorbidities of the trunk or the lower limbs interfering with upright posture and walking function (eg, amputation or fracture of lower limb). Other neuromuscular
or neurological disease and/or syndromes causing weakness in patients in the ICU (we will exclude patients with diseases and syndromes causing weakness in patients in the ICU,8 due to Guillain-Barré syndrome, myasthenia gravis, porphyria, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, vasculitic neuropathy, cervical myelopathy and botulism). Severe physical comorbidity before becoming critical ill (eg, frailty due to neurological conditions). Procedure Eligible patients will be screened and afterwards will Anacetrapib get oral and written information about the study from their treating physician or researcher. After written informed consent the demographic and clinical characteristics will be measured (baseline assessment T0). Patients will then be measured every 2 weeks after baseline up to 20 weeks (week 2 (T1), week 4 (T2), week 6 (T3), week 8 (T4) week 10 (T5) and so on until week 20 (T10)). Two follow-ups are planned: FU1 after 6-month and FU2 after 1 year after study entry. For follow-up assessments (FU1 and FU2), patients and their guardians will be informed and invited by letter and telephone to participate. The amount and the content of physical rehabilitation, activities of daily life such as the ability to walk will be documented every day by physiotherapists and occupational therapist using predefined sheets.