Risk factors for ICU-acquired weakness in patients undergoing mechanical ventilation: a systematic review and...

Area of Science:

• Critical Care Medicine
• Neurology
• Pharmacology

Background:

• Intensive care unit (ICU)-acquired weakness (ICU-AW) is a common complication in patients on mechanical ventilation (MV).
• The association between corticosteroid (CS) exposure and ICU-AW is inconsistent, and other clinical factors remain unclear.
• This study investigates risk factors for ICU-AW, focusing on CS use in MV patients.

Purpose of the Study:

• To systematically review and meta-analyze the risk factors associated with ICU-acquired weakness (ICU-AW) in patients undergoing mechanical ventilation (MV).
• To specifically examine the contribution of corticosteroid (CS) use to the development of ICU-AW.
• To identify specific patient characteristics and clinical factors that increase the risk of ICU-AW in this population.

Main Methods:

• A systematic search of multiple databases (PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, VIP, CBM) was conducted up to December 2024.
• Quality appraisal of cohort studies used the Newcastle-Ottawa Scale (NOS), and randomized controlled trials (RCTs) were assessed using the Revised Cochrane Risk-of-Bias Tool (ROB2).
• A meta-analysis was performed using Stata 16 software.

Main Results:

• The meta-analysis included 2 RCTs and 19 cohort studies, totaling 6,894 patients.
• Corticosteroid (CS) use was significantly associated with an increased incidence of ICU-acquired weakness (ICU-AW) in mechanical ventilation (MV) patients (RR = 1.52, 95% CI: 1.31-1.76).
• Identified risk factors for ICU-AW included prolonged MV duration, advanced age, high-dose/long-term CS use, hyperglycemia, elevated lactate, high APACHE II scores, higher BMI, and extended ICU length of stay (LOS).

Conclusions:

• Corticosteroid (CS) use is a significant risk factor for ICU-acquired weakness (ICU-AW) in mechanical ventilation (MV) patients.
• Specific patient characteristics associated with increased ICU-AW risk include MV duration ≥8 days, age ≥60 years, long-term high-dose CS use (≥1 g), CS use >7 days, hyperglycemia (>13 mmol/L), elevated lactate (≥4 mmol/L), APACHE II score ≥19, BMI ≥24 kg/m2, and ICU LOS >14 days.