Letter to the Editor
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2024; 12(18): 3644-3647
Published online Jun 26, 2024. doi: 10.12998/wjcc.v12.i18.3644
Intensive care unit-acquired weakness and mechanical ventilation: A reciprocal relationship
Ranjeet Kumar Sinha, Sony Sinha, Prateek Nishant, Arvind Kumar Morya
Ranjeet Kumar Sinha, Department of Community Medicine, Patna Medical College, Bihar, Patna 800004, India
Sony Sinha, Department of Ophthalmology-Vitreo-Retina, Neuro-Ophthalmology and Oculoplasty, All India Institute of Medical Sciences, Bihar, Patna 801507, India
Prateek Nishant, Department of Ophthalmology, ESIC Medical College, Bihar, Patna 801113, India
Arvind Kumar Morya, Department of Ophthalmology, All India Institute of Medical Sciences, Telangana, Hyderabad 508126, India
Author contributions: Sinha RK designed the research; Nishant P and Sinha S performed the research; Sinha S and Nishant P analyzed the data and wrote the letter; Morya AK revised the letter.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arvind Kumar Morya, Doctor, MBBS, MNAMS, Academic Editor, Additional Professor, Doctor, Instructor, Researcher, Teacher, Department of Ophthalmology, All India Institute of Medical Sciences, Bibi Nagar, Telangana, Hyderabad 508126, India. bulbul.morya@gmail.com
Received: March 2, 2024
Revised: April 21, 2024
Accepted: May 8, 2024
Published online: June 26, 2024
Processing time: 107 Days and 20.7 Hours
Abstract

Intensive care unit-acquired weakness (ICU-AW; ICD-10 Code: G72.81) is a syndrome of generalized weakness described as clinically detectable weakness in critically ill patients with no other credible cause. The risk factors for ICU-AW include hyperglycemia, parenteral nutrition, vasoactive drugs, neuromuscular blocking agents, corticosteroids, sedatives, some antibiotics, immobilization, the disease severity, septicemia and systemic inflammatory response syndrome, multiorgan failure, prolonged mechanical ventilation (MV), high lactate levels, older age, female sex, and pre-existing systemic morbidities. There is a definite association between the duration of ICU stay and MV with ICU-AW. However, the interpretation that these are modifiable risk factors influencing ICU-AW, appears to be flawed, because the relationship between longer ICU stays and MV with ICU-AW is reciprocal and cannot yield clinically meaningful strategies for the prevention of ICU-AW. Prevention strategies must be based on other risk factors. Large multicentric randomized controlled trials as well as meta-analysis of such studies can be a more useful approach towards determining the influence of these risk factors on the occurrence of ICU-AW in different populations.

Keywords: Critical illness, Meta-analysis, Morbidity, Myopathy, Polyneuropathy, Risk factors

Core Tip: Intensive care unit-acquired weakness (ICU-AW; ICD-10 Code: G72.81), an unspecified neuromuscular weakness in critically ill patients, continues to be a key concern in ICU patients and survivors. There is a definite association between the duration of ICU stay and mechanical ventilation (MV) with ICU-AW. However, the interpretation that these are modifiable risk factors influencing ICU-AW, appears to be flawed, because the relationship between longer ICU stays and MV with ICU-AW is reciprocal and cannot yield clinically meaningful strategies for the prevention of ICU-AW. Prevention strategies must be based on other risk factors.