The priming factor in CIM is triggered by which of the following?

The priming factor in CIM is triggered by which of the following?

• A. Spontaneous resolution of illness
• B. Adequate rest
• C. Low-calorie diet
• D. Major surgery, trauma, or the use of NMBA

Answer: (D)

In Critical Illness Myopathy, there is an initiating event that primes the muscles to fail under a severe illness. The classic priming factors are major surgery, major trauma, or the use of neuromuscular blocking agents, because these stressors provoke a systemic inflammatory response and a strong catabolic state that directly affect skeletal muscle and its excitation-contraction machinery. This combination accelerates muscle weakness and atrophy seen in CIM. Spontaneous resolution of illness, adequate rest, or a low-calorie diet do not serve as the same triggering events. Rest and recovery reduce inflammatory stress, and while malnutrition can worsen muscle wasting, it is not the initiating priming event for CIM in the way that major surgery, trauma, or NMBA use are.

In Critical Illness Myopathy, there is an initiating event that primes the muscles to fail under a severe illness. The classic priming factors are major surgery, major trauma, or the use of neuromuscular blocking agents, because these stressors provoke a systemic inflammatory response and a strong catabolic state that directly affect skeletal muscle and its excitation-contraction machinery. This combination accelerates muscle weakness and atrophy seen in CIM.

Spontaneous resolution of illness, adequate rest, or a low-calorie diet do not serve as the same triggering events. Rest and recovery reduce inflammatory stress, and while malnutrition can worsen muscle wasting, it is not the initiating priming event for CIM in the way that major surgery, trauma, or NMBA use are.