ICU-Acquired Weakness: An Unsolved Clinical Problem: A Narrative Review

Area of Science:

• Critical care medicine
• Neurology
• Physical rehabilitation

Background:

• Intensive care unit-acquired weakness (ICUAW) is a frequent and severe complication in critically ill patients.
• It involves skeletal muscle weakness (myopathy), peripheral nerve dysfunction (polyneuropathy), or both (polyneuromyopathy).
• Risk factors include prolonged ventilation, immobilization, and critical illness severity.

Purpose of the Study:

• To review current diagnostic tools, management strategies, and prognosis for ICUAW.
• To highlight challenges in diagnosis and the need for improved methods.
• To identify emerging research areas for earlier detection and intervention.

Main Methods:

• Review of existing literature on ICUAW diagnosis, risk factors, and management.
• Discussion of current assessment tools like MRC-SS and handgrip dynamometry.
• Exploration of limitations of current diagnostic methods and potential of new approaches.

Main Results:

• ICUAW diagnosis is often delayed and relies on excluding other causes.
• Current assessment tools (MRC-SS, dynamometry) are often impractical for severely ill patients.
• Effective diagnostic tools and understanding of pathophysiology are lacking, limiting management to rehabilitation.

Conclusions:

• ICUAW significantly increases morbidity and mortality, leading to long-term disability.
• There is an urgent need for reliable, early diagnostic methods for ICUAW.
• Future research in biomarkers and risk prediction models holds promise for improved patient outcomes.