25180722
BACKGROUND	ICU-acquired weakness ( ICU-AW ) has immediate and long-term consequences for critically ill patients .
BACKGROUND	Strategies for the prevention of weakness include modification of known risk factors , such as hyperglycemia and immobility .
BACKGROUND	Intensive insulin therapy ( IIT ) has been proposed to prevent critical illness polyneuropathy .
BACKGROUND	However , the effect of insulin and early mobilization on clinically apparent weakness is not well known .
METHODS	This is a secondary analysis of all patients with mechanical ventilation ( N = 104 ) previously enrolled in a randomized controlled trial of early occupational and physical therapy vs conventional therapy , which evaluated the end point of functional independence .
METHODS	Every patient had IIT and blinded muscle strength testing on hospital discharge to determine the incidence of clinically apparent weakness .
METHODS	The effects of insulin dose and early mobilization on the incidence of ICU-AW were assessed .
RESULTS	On logistic regression analyses , early mobilization and increasing insulin dose prevented the incidence of ICU-AW ( OR , 0.18 , P = .001 ; OR , 0.001 , P = .011 ; respectively ) independent of known risk factors for weakness .
RESULTS	Early mobilization also significantly reduced insulin requirements to achieve similar glycemic goals as compared with control patients ( 0.07 units/kg/d vs 0.2 units/kg/d , P < .001 ) .
CONCLUSIONS	The duel effect of early mobilization in reducing clinically relevant ICU-AW and promoting euglycemia suggests its potential usefulness as an alternative to IIT .

