CURRENT STRATEGIES FOR PREVENTION AND MANAGEMENT OF ICU-ACQUIRED WEAKNESS IN CRITICALLY ILL PATIENTS: EVIDENCE, LIMITATIONS AND CLINICAL APPLICABILITY - A NARRATIVE REVIEW

Julia Suchecka; Wiktor  Nesterak; Izabela Szubert; Jakub Lamorski; Gabriela Stępień; Karolina Chudecka; Michał Chylewski; Katarzyna Józwa; Aleksandra Kędzierska; Urszula Przewoźna

doi:10.31435/ijitss.2(50).2026.5909

Authors

Julia Suchecka Independent Public Provincial Integrated Hospital in Szczecin, Sczecin, Poland https://orcid.org/0009-0001-9975-355X
Wiktor Nesterak Pomeranian Medical University in Szczecin, Szczecin, Poland https://orcid.org/0009-0009-5322-903X
Izabela Szubert Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0006-7162-6651
Jakub Lamorski Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0004-5456-7413
Gabriela Stępień University Clinical Hospital No. 2 PMU in Szczecin, Szczecin, Poland https://orcid.org/0009-0006-4505-5162
Karolina Chudecka Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0004-0262-5036
Michał Chylewski University Clinical Hospital No. 1 PMU in Szczecin, Szczecin, Poland https://orcid.org/0009-0007-4789-1903
Katarzyna Józwa Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0003-5615-2388
Aleksandra Kędzierska Independent Public Provincial Integrated Hospital in Szczecin, Szczecin, Poland https://orcid.org/0009-0008-7050-4139
Urszula Przewoźna University Clinical Hospital No. 2 PMU in Szczecin, Szczecin, Poland https://orcid.org/0009-0003-2186-6604

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5909

Keywords:

Intensive Care Unit-Acquired Weakness; Critical Illness; Early Mobilization; Nutritional Support; Neuromuscular Electrical Stimulation; Muscle Assessment

Abstract

Intensive care unit-acquired weakness (ICU-AW) is a common complication of critical illness, defined as generalized, symmetrical muscle weakness developing during ICU stay that cannot be explained by pre-existing neuromuscular disorders. It is associated with prolonged mechanical ventilation, delayed recovery, and impaired long-term functional outcomes. The objective of this narrative review was to summarize current evidence on strategies for the prevention and early management of ICU-AW, with a particular focus on their effectiveness, limitations, and clinical applicability.

A structured literature search was conducted using PubMed, MEDLINE, and Google Scholar databases, focusing on randomized controlled trials, systematic reviews, and meta-analyses published between 2018 and 2026. Particular attention was given to early mobilization, nutritional support, neuromuscular electrical stimulation (NMES), sedation strategies, and methods for assessing muscle status.

Current evidence suggests that ICU-AW results from multiple interacting factors, including systemic inflammation, metabolic disturbances, immobilization, and inadequate nutritional support. Early mobilization remains the most consistently supported intervention, while nutritional therapy and NMES may provide additional benefits, particularly in selected patient populations. Monitoring of muscle status may facilitate early detection and guide clinical decision-making.

Individual strategies for the prevention and early management of ICU-AW have important limitations when used in isolation. The available evidence suggests that different approaches may have complementary effects, although their combined impact remains incompletely understood. Further research is needed to better define optimal intervention strategies, including their timing, combination, and applicability in diverse patient populations.

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