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Cited by 193Intensive Care Unit Cognitive DisordersClinical Nutrition and GastroenterologyRespiratory Support and Mechanisms

Muscular weakness and muscle wasting in the critically ill

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Schefold, Joerg C., Wollersheim, Tobias, Grunow, Julius J., Luedi, Markus M., Z'Graggen, Werner J., Weber‐Carstens, Steffen·2020·Journal of Cachexia, Sarcopenia and Muscle
DOI 10.1002/jcsm.12620PMC PMC7749542
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Abstract

Background: Muscular weakness and/or muscle wasting is recognized as a key medical problem in critically ill patients on intensive care units (ICUs) worldwide. Methods and Results: Intensive care unit‐acquired weakness (ICUAW) results from various diseases leading to critical illness and is observed in about 40% [1080/2686 patients, 95% confidence interval (CI): 38–42%] of mixed (medical–surgical) ICU patients. Muscle strength at ICU discharge is directly associated with mortality 5 years after discharge [hazard ratio 0.946, 95% CI: 0.928–0.968 per point increase in Medical Research Council (MRC) scores, P = 0.001]. ICUAW serves as umbrella term for the subgroups ‘critical illness myopathy’, ‘critical illness polyneuropathy’, and ‘critical illness polyneuromyopathy’, the latter distinguished using electrophysiology and/or biopsy studies. Diagnosing, studying, and developing treatments for ICUAW among the critically ill seems challenging due to the acuity and severity of the underlying heterogeneous diseases. Ventilator‐induced diaphragmatic dysfunction occurs in up to 80% ( n = 32/40) of ICUAW patients after mechanical ventilation and mostly results from distinct muscular pathologies, disuse, underlying critical illness, and/or effects imposed directly by mechanical ventilation. Swallowing disorders/dysphagia likely represent an additional (local) neuromuscular dysfunction/ICUAW sequelae and presents in 10.3% ( n = 96/933) of mixed medical–surgical ICU survivors, with 60.4% ( n = 58/96) of patients remaining dysphagia positive until hospital discharge. Key independent risk factors for dysphagia following mechanical ventilation are baseline neurological disease [odds ratio (OR) 4.45, 95% CI: 2.74–7.24, P < 0.01], emergency admission (OR 2.04, 95% CI: 1.15–3.59, P < 0.01), days on mechanical ventilation (OR 1.19, 95% CI: 1.06–1.34, P < 0.01), days on renal replacement therapy (OR 1.1, 95% CI: 1–1.23, P = 0.03), and disease severity (Acute Physiology and Chronic Health Evaluation II score within first 24 h; OR 1.03, 95% CI: 0.99–1.07, P < 0.01). Dysphagia positivity independently predicts 28‐day and 90‐day mortality (90‐day univariate hazard ratio: 3.74; 95% CI, 2.01–6.95; P < 0.001) and is associated with a 9.2% excess (all‐cause) mortality rate. Conclusions: Neuromuscular weakness and muscle wasting is observed in many survivors of critical illness. ICUAW, ventilator‐induced diaphragmatic dysfunction, and dysphagia are associated with complicated and prolonged ICU stay, impaired weaning from mechanical ventilation, impeded rehabilitative measures, and a considerable impact on morbidity and mortality is noted. Future research strategies should further explore underlying pathomechanisms and lead to development of causal treatment strategies.

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  • Prolonged bed rest is associated with health deficits and functional impairment.

    “Prolonged bed rest is associated with health deficits and functional impairment (1).”

    From Nonuniform loss of muscle strength and atrophy during bed rest: a systematic review (2021) · cites this paper as [1]

    The ICU-acquired weakness-associated complications section states that prolonged bed rest in critically ill patients increases the risk of comorbidities, supporting the health-deficits portion. The Introduction links impaired mobilization and prolonged bed rest as consequences of muscular weakness, but does not establish functional impairment as a consequence of bed rest. The claim also omits the paper’s critically ill patient context. (LLM, conf=0.82)

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Cited by

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Authors
Schefold, J. C., Wollersheim, T., Grunow, J. J., Luedi, M. M., Z'Graggen, W. J., & Weber‐Carstens, S.
Affiliations
  • University of Bern (CH)
  • Humboldt-Universität zu Berlin (DE)
Corresponding author
Schefold, Joerg C.
ORCID
Venue
Journal of Cachexia, Sarcopenia and Muscle
Publisher
Wiley
Published
2020-09-07
Volume
11
Issue
6
Pages
1399-1412
ISSN
  • 2190-5991 (ISSN-L)
  • 2190-6009
DOI
10.1002/jcsm.12620
PMC
PMC7749542
OpenAlex
W3084022240
Cited by
193
References
9
Citations by year
2026: 38 · 2025: 44 · 2024: 36 · 2023: 37 · 2022: 26 · 2021: 11 · 2020: 1
FWCI
3.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Cachexia Sarcopenia and Muscle (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by)
  • Open Access CRIS of the University of Bern
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords
ICU-acquired weakness, critical illness myopathy, critical illness polyneuropathy, critical illness polyneuromyopathy, ventilator-induced diaphragm dysfunction, dysphagia, mechanical ventilation, muscle atrophy, muscle strength, mortality, risk factors, intensive care unit, post-ICU recovery, neuromuscular dysfunction, renal replacement therapy
MeSH terms
Female, Humans, Intensive Care Units, Male, Muscles, Muscular Diseases, Polyneuropathies, Critical Illness, Muscle Weakness

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