Intensive care unit‐acquired weakness and the COVID‐19 pandemic: A clinical review

Abstract

Patients with severe cases of coronavirus disease 2019 (COVID‐19) often become critically ill requiring intensive care unit (ICU) management. These individuals are at risk for developing ICU‐acquired weakness (ICUAW), a multifactorial condition in which polyneuropathy, myopathy, and/or disuse muscle atrophy result in motor weakness. This weakness is thought to contribute to the long‐term functional disability frequently observed in survivors of critical illness. This review discusses the current evidence regarding the epidemiology, pathophysiology, evaluation, risk factors, and rehabilitation‐specific management of ICUAW in patients with COVID‐19. Because of the novelty of COVID‐19, the exact prevalence of ICUAW is not well delineated among COVID‐19 patients. However, ICUAW has been reported in this population with retrospective studies showing weakness occurring in up to 45.5% of patients with severe COVID‐19. There are multiple risk factors for developing ICUAW among COVID‐19 patients, including premorbid health status, sepsis, multiple organ failure, mechanical ventilation, immobilization, neuromuscular blockade, corticosteroid use, and glycemic control. ICUAW is more likely to occur after prolonged mechanical ventilation and long hospital stays and can be diagnosed with manual muscle and electrodiagnostic testing. Although the long‐term sequela of COVID‐19 after ICU stays is not fully studied, increasing evidence indicates significant risk for this population developing long‐term functional impairments. Establishing postacute rehabilitation programs for COVID‐19 survivors will be important for recovery of endurance, mobility, and function.

Implementation of Early Rehabilitation in Severe COVID-19 Respiratory Failure

“… 42 , 43 Based on the limited evidence for individuals with COVID-19, ICUAW continues to be concerning and prevalent in this population. 10 , 11 , 17 …”

“…4,5 Patients with COVID-19 often experience respiratory failure but may have additional symptoms including anorexia, nausea and diarrhea, myocarditis, skeletal muscle myopathy, and generalized debility. [6][7][8][9][10][11][12][13][14] These patients are at risk of substantial deconditioning as they are confined to bed from systemic symptoms as well as profound hypoxemia.…”

“…15,16 Patients admitted to an ICU with COVID-19 are at high risk of developing intensive care unit acquired weakness (ICUAW). 10 The exact incidence of ICUAW in individuals with COVID-19 requiring ICU-level of care is unknown; however, recent studies suggest that it may range between 27% and 72%. 10,17 Intensive care unit acquired weakness has been correlated with increased length of ICU stay, difficulty weaning from mechanical ventilation, impaired mobility performance, diminished exercise tolerance, decreased independence with activities of daily living at discharge, and lower quality of life.…”

“… 10 The exact incidence of ICUAW in individuals with COVID-19 requiring ICU-level of care is unknown; however, recent studies suggest that it may range between 27% and 72%. 10 , 17 Intensive care unit acquired weakness has been correlated with increased length of ICU stay, difficulty weaning from mechanical ventilation, impaired mobility performance, diminished exercise tolerance, decreased independence with activities of daily living at discharge, and lower quality of life. 8 , 17 A recent prospective observational study of 75 patients with COVID-19 admitted to the ICU for more than 72 hours found that bed rest time was independently associated with the development of ICUAW.…”

“…The strains on the health care system during a pandemic characterized by an increased incidence of severe respiratory failure have meant that paradigm shifts are especially profound in the intensive care unit (ICU) 4,5. Patients with COVID-19 often experience respiratory failure but may have additional symptoms including anorexia, nausea and diarrhea, myocarditis, skeletal muscle myopathy, and generalized debility 6–14. These patients are at risk of substantial deconditioning as they are confined to bed from systemic symptoms as well as profound hypoxemia.…”