ICU-ACQUIRED WEAKNESS: INCIDENCE, PREDICTORS, AND OUTCOMES -A SYSTEMATIC REVIEW
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Keywords
ICU-acquired weakness, critical illness myopathy, critical illness polyneuropathy, sepsis
Abstract
Background: ICU-acquired weakness (ICUAW) is a well-documented yet frequently underrecognized complication in critically ill patients that leads to marked functional decline, extended mechanical ventilation, and elevated mortality risk. Despite its clinical significance, prospective data from South Asian tertiary care settings remain sparse.
Objective: This systematic review aimed to determine the incidence of ICUAW among adult patients admitted to the RAJENDRA INSTITUTE OF MEDICAL SCIENCES, (RIMS) Intensive Care Unit from January 2020 to August 2022, identify independent clinical predictors, and evaluate associated short- and long-term outcomes.
Methods: A total of 240 adult ICU patients who met eligibility criteria were enrolled. Diagnosis of ICUAW was made using the Medical Research Council (MRC) sum score, with a threshold of below 48 indicating clinically significant weakness. Data on demographics, illness severity, therapeutic exposures, and clinical outcomes were systematically extracted and analyzed. Multivariate logistic regression was performed to identify independent predictors. The review was conducted in accordance with PRISMA 2020 guidelines.
Results: ICUAW was diagnosed in 87 of 240 patients, yielding an incidence of 36.25%. Independent predictors included mechanical ventilation duration exceeding seven days (OR 4.82; 95% CI 2.63–8.84), sepsis (OR 3.14; 95% CI 1.72–5.73), and corticosteroid use beyond five days (OR 2.47; 95% CI 1.37–4.45). ICU mortality was significantly higher among those with ICUAW (35.6% vs. 11.8%, p<0.001). Functional independence at six months was attained by only 35.6% of ICUAW patients compared to 73.2% of unaffected individuals.
Conclusion: ICUAW carries substantial clinical burden in tertiary ICU settings. Prolonged mechanical ventilation, sepsis, and modifiable pharmacological exposures represent actionable targets for risk-reduction strategies. Early recognition and rehabilitation-focused care bundles are strongly advocated.
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Dr. (Major) Sourabh Kumar
Assistant Professor, Intensive Care, Department of Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Dr. Kriti Prasad
Consultant & Senior IVF Specialist, Seeds of Innocens, Ranchi, Jharkhand, India.
Dr. Bharati
Assistant Professor, Department of Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Dr. Ramesh Kumar Kharwar
Assistant Professor, Intensive Care, Department of Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Dr. Saurabh Toppo
Senior Consultant Anaesthesiologist, Bhagwan Mahavir Hospital, Ranchi, Jharkhand, India .
Dr. Shio Priye
Professor, Department of Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Dr. Ladhu Lakra
Professor & Head, Department of Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
