Multidisciplinary care for ICU-Acquired Weakness in Adults: a scoping review
DOI:
https://doi.org/10.15343/0104-7809.202650e18952025PKeywords:
Muscle Weakness, Early Ambulation, Disease Prevention, Critical Care, Intensive Care UnitsAbstract
This scoping review aimed to map evidence on multiprofessional care recommendations and protocols for adults with ICU-acquired weakness (ICU-AW), identifying practices and gaps in the literature. The review was conducted in accordance with the methodological recommendations of the Joanna Briggs Institute and reported following the PRISMA-ScR checklist. The search was performed in March 2025 in the MEDLINE/PubMed, BVS, Scopus, Web of Science, and Cochrane Library databases, using DeCS/MeSH descriptors combined with free-text terms. Original articles, reviews, and clinical guidelines published from 2020 onwards, in English, Portuguese, or Spanish, were included. A total of 734 records were identified, of which 373 remained after duplicate removal. Following screening and full text reading, 17 studies were included. The findings indicate the use of strategies such as early mobilization, neuromuscular electrical stimulation, and multiprofessional care organization in the management of ICU-AW. Heterogeneity among interventions was observed, as well as the absence of widely standardized and integrated protocols in the intensive care context. It is concluded that, although different strategies are described in the literature, gaps persist regarding the standardization and integration of multiprofessional care, highlighting the need for studies that support the consolidation of more consistent recommendations for clinical practice.
Downloads
Translations of this article
References
Latronico N, Rasulo FA, Eikermann M, Piva S. Intensive care unit-acquired weakness, polyneuropathy and myopathy: diagnosis, treatment and long-term outcomes. Crit Care. 2023;27(1):439. doi:10.1186/s13054-023-04676-3.
Yang Z, Wang X, Wang F, Peng Z, Fan Y. A systematic review and meta-analysis of risk factors for intensive care unit-acquired weakness. Medicine (Baltimore). 2022;101(43):e31405. doi:10.1097/MD.0000000000031405.
Machado JC, Castro MG, Giacomassi IWS, Giorelli GV, Isola AM, Silva Junior JM, et al. Bundles no combate à fraqueza adquirida na unidade de terapia intensiva. BRASPEN J. 2023;36(2):131-144. doi:10.37111/braspenj.2021.36.2.01.
Zhang Y, Hu Q, Zhou M, Wang Y, Yang J, Jin X, et al. Risk factors for acquired weakness in intensive care unit patients: an umbrella review. Intensive Crit Care Nurs. 2025;88:103940. doi:10.1016/j.iccn.2025.103940.
García-Pérez-de-Sevilla G, Sánchez-Pinto B. Effectiveness of physical exercise and neuromuscular electrical stimulation interventions to prevent and treat ICU-acquired weakness: a systematic review of randomized clinical trials. Intensive Crit Care Nurs. 2023;74:103333. doi:10.1016/j.iccn.2022.103333.
Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, et al. Early mobilization of critically ill patients in the intensive care unit: a systematic review and meta analysis. PLoS One. 2019;14(10):e0223185. doi:10.1371/journal.pone.0223185.
Yang T, Li Z, Jiang L, Xi X. Corticosteroid use and intensive care unit-acquired weakness: a systematic review and meta-analysis. Crit Care. 2018;22(1):187. doi:10.1186/s13054-018-2111-0.
Yang T, Li ZQ, Li HL, Zhou JX, Chen GQ. Aminoglycoside use and intensive care unit-acquired weakness: a systematic review and meta-analysis. PLoS One. 2020;15(3):e0230181. doi:10.1371/journal.pone.0230181.
Sun R, Jiang H, Wang J, Yu J, Zhou Q, Fang K, et al. Summary of the best evidence for early exercise rehabilitation in patients with mechanically ventilated ICU-acquired weakness. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024;36(7):745-752. doi:10.3760/cma.j.cn121430-20240227-00169.
Nakanishi N, Yoshihiro S, Kawamura Y, Aikawa G, Shida H, Shimizu M, et al. Effect of neuromuscular electrical stimulation in patients with critical illness: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care Med. 2023;51(10):1386-1396. doi:10.1097/ CCM.0000000000005941.
Anekwe DE, Biswas S, Bussières A, Spahija J. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis. Physiotherapy. 2020;107:1-10. doi:10.1016/j.physio.2019.12.004.
Klawitter F, Walter U, Axer H, Ehler J. Intensive care unit-acquired weakness: diagnostic value of neuromuscular ultrasound. Anaesthesiologie. 2023;72(8):543-554. doi:10.1007/s00101-023-01300-5.
Yang T, Wang Y, Xi X, Yu S. Association between vasopressor use and intensive care unit-acquired weakness: a meta-analysis. Brain Behav. 2024;14(9):e70012. doi:10.1002/brb3.70012.
García-Martínez MÁ, Montejo González JC, García-de-Lorenzo y Mateos A, Teijeira S. Muscle weakness: understanding the principles of myopathy and neuropathy in the critically ill and management options. Clin Nutr. 2020;39(5):1331-1344. doi:10.1016/j.clnu.2019.05.027.
Elkalawy H, Sekhar P, Abosena W. Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review. Acute Crit Care. 2023;38(4):409-424. doi:10.4266/acc.2023.00703.
Raurell-Torredà M, Arias-Rivera S, Martí JD, Frade-Mera MJ, Zaragoza-García I, Gallart E, et al. Care and treatments related to intensive care unit acquired weakness: a cohort study. Aust Crit Care. 2021;34(5):435-445. doi:10.1016/j.aucc.2020.12.005.
Xu Q, Tan J, Wang Y, Tang M. Theory- and evidence-based nursing interventions for ICU-acquired weakness prevention in intensive care units: a systematic review. PLoS One. 2024;19(9):e0308291. doi:10.1371/journal.pone.0308291.
Giraldo ND, Carvajal C, Muñoz F, Restrepo MP, García MA, Arias JM, et al. Reducing intensive care unit-acquired weakness with a multicomponent protocol implementation: a quasi-experimental clinical trial. Biomédica. 2023;43(4):438-446. doi:10.7705/biomedica.6947.
Zhou W, Yu L, Fan Y, Shi B, Wang X, Chen T, et al. Effect of early mobilization combined with early nutrition on acquired weakness in critically ill patients (EMAS): a dual-center randomized controlled trial. PLoS One. 2022;17(5):e0268599. doi:10.1371/journal.pone.0268599.
Zhou Y, Sun Y, Pan Y, Dai Y, Xiao Y, Yu Y. Risk prediction models for intensive care unit-acquired weakness in critically ill patients: a systematic review. Aust Crit Care. 2025;38(1):101066. doi:10.1016/j.aucc.2024.05.003.
Witteveen E, Wieske L, Sommers J, et al. Early prediction of intensive care unit-acquired weakness: a multicenter external validation study. J Intensive Care Med. 2020;35(6):595-605. doi:10.1177/0885066618771001.
Aquim EE, Bernardo WM, Buzzini RF, Azeredo NS, Cunha LS, Damasceno MC, et al. Brazilian guidelines for early mobilization in intensive care units. Rev Bras Ter Intensiva. 2019;31(4):434-443. doi:10.5935/0103-507X.20190084.
Parra BFCS, Matos LBN, Ferrer R, Toledo DO. SARCPRO: protocolo multiprofissional para o manejo da sarcopenia em pacientes hospitalizados. BRASPEN J. 2023;38(1):27-34.
Toledo DO, Silva DCLE, Santos DMD, Freitas BJ, Dib R, Cordioli RL, et al. Bedside ultrasound is a practical measurement tool for assessing muscle mass. Rev Bras Ter Intensiva. 2017;29(4):476-480. doi:10.5935/0103-507X.20170071.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 O Mundo da Saúde
This work is licensed under a Creative Commons Attribution 4.0 International License.
