Intensive care unit-acquired weakness: A review from molecular mechanisms to its impact in COVID-2019

Abstract

Intensive Care Unit-Acquired Weakness (ICU-AW) is a generalized and symmetric neuromuscular dysfunction associated with critical illness and its treatments. Its incidence is approximately 80% in intensive care unit patients, and it manifests as critical illness polyneuropathy, critical illness myopathy, and muscle atrophy. Intensive care unit patients can lose an elevated percentage of their muscle mass in the first days after admission, producing short- and long-term sequelae that affect patients’ quality of life, physical health, and mental health. In 2019, the world was faced with coronavirus disease 2019 (COVID-19), caused by the acute respiratory syndrome coronavirus 2. COVID-19 produces severe respiratory disorders, such as acute respiratory distress syndrome, which increases the risk of developing ICU-AW. COVID-19 patients treated in intensive care units have shown early diffuse and symmetrical muscle weakness, polyneuropathy, and myalgia, coinciding with the clinical presentation of ICU-AW. Besides, these patients require prolonged intensive care unit stays, invasive mechanical ventilation, and intensive care unit pharmacological therapy, which are risk factors for ICU-AW. Thus, the purposes of this review are to discuss the features of ICU-AW and its effects on skeletal muscle. Further, we will describe the mechanisms involved in the probable development of ICU-AW in severe COVID-19 patients.

Has COVID-19 lowered physical activity practice while boosting online searches for professional exercise information?

“…COVID-19 pandemic was caused by a virus, but its consequences developed to several different areas of health. This clustering of health related aspects led us to consider the COVID-19 a syndemic instead of a pandemic, as presented by Singer and Clair (2003), 9 due to the complex interaction between the original problems caused by the virus infection and the other problems that appeared from there. One of these secondary problems is the reduction in the amount of physical activity that was done by the population.…”

“…Muscle weakness due to physical inactivity can cause severe damage to health. Gonzales et al (2022) 10 showed that risk factors for weakness muscle can be classified as modifiable and no modifiable. Modifiable risk includes hyperglycemia and other critical diseases.…”

Critical illness-associated limb and diaphragmatic weakness

“…As evidence, severity scores correlate highly with CIW [ 15 ]. Sepsis [ 16 ] and moderate to severe acute respiratory distress syndrome (ARDS) are important risk factors for CIW [ 15 , 17 , 18 ]. Emerging data suggest that acute kidney injury (AKI) may contribute to CIW involving interacting factors such as altered amino-acid metabolism, systemic inflammation, and immobility [ 19 ].…”

Effect of physical activity on long COVID fatigue: an unsolved enigma

“… 15 This situation has been made more complex by the more or less long periods of shut down, which have caused widespread stress among the population, as they have restricted social relations by altering daily routines, with a reduction in travel and physical activity, often in the context of increased social and economic insecurity. 16 This has led to an increase in physical symptoms, independent of COVID infection. 17 Given that in many cases baseline data on pre-morbid symptoms were not available, the effect of COVID-19 on pre-existing symptoms cannot be assessed.…”