New Onset Weakness in Critically Ill Patients and the Risk of Death and Recurrent ICU Admission

Inclusion Criteria: * Adult (age \> or = 18) patients admitted to the Medical ICU * Respiratory failure requiring mechanical ventilation \> or = 5 days * Reasonable expectation for a subsequent return of mental status Exclusion Criteria: * Patient's family, physician, or both not in favor of aggressive treatment of patient or presence of an advanced directive to withhold life-sustaining treatment * Pregnancy * Admitted to ICU from outside hospital * New or pre-existing diagnosis causing current neuromuscular weakness * Profound and uncorrectable hypokalemia or hypophosphatemia \[K \< 2.5 or P \< 1.0 throughout enrollment window\] * Inability to assess muscle strength in more than six muscle groups in at least two extremities \[Bilateral amputation (BKA or AKA), severe burns, skin lesions or dressings limiting ability of examiner to access and forcibly resist movement of the patients extremities\] * Inability to communicate or follow commands of the examiner \[persistent coma, severe MRDD (mental retardation and developmental disabilities) or continuing necessary medication use that impairs consciousness (i.e. narcotics), non-English speaker\] * Concurrent enrollment in another clinical trial involving steroids \> 20 mg/day prednisone equivalent for \> 3 days, neuromuscular blockade for \> 24 hours or any aminoglycosides. * Prisoner or other subject where legal surrogate decision maker is in question