Intensive care unit acquired weakness: an update in the context of respiratory virus infection

Intensive care unit-acquired weakness (ICUAW) is one of the most common neuromuscular impairments featuring symmetric and generalized weakness, and typically occurs in critically ill patients, particularly those with sepsis. Mechanistically, ICUAW shares overlapping immunological networks with respiratory viruses. While accumulating evidence supports an association between Guillain-Barré syndrome (GBS) and respiratory viruses, the causal relationship between ICUAW and these pathogens has not been sufficiently documented.

This review summarizes current knowledge on the classification, diagnosis, and management of ICUAW, with a focus on its potential association with respiratory viruses. Relevant literature was collected from PubMed, Web of Science, Cochrane Library, and Google Scholar, focusing on English-language studies published between January 2019 and March 2026. This review addressed differential diagnostic challenges, potential pathogenic mechanisms, therapeutic interventions, and preventive strategies of ICUAW.

Emerging evidence suggests that respiratory viruses may exacerbate ICUAW, highlighting timely interventions combining biomarkers such as Interleukin (IL)-6 and Growth Differentiation Factor (GDF)-15 as promising therapeutic targets. Standardization of diagnostic criteria, refinement of animal models, and individualized rehabilitation strategies are warranted. Future studies on ICUAW should emphasize early assessment of muscle strength, evaluation of nutritional therapy efficacy, and prevention of complications.