Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2024; 12(19): 3665-3670
Published online Jul 6, 2024. doi: 10.12998/wjcc.v12.i19.3665
Intensive care unit-acquired weakness – preventive, and therapeutic aspects; future directions and special focus on lung transplantation
Thirugnanasambandan Sunder
Thirugnanasambandan Sunder, Department of Heart Lung Transplantation and Mechanical Circulatory Support, Apollo Hospitals, Chennai 600086, Tamil Nadu, India
Author contributions: Sunder T designed the overall concept, outline of the manuscript, the discussion and design of the manuscript; contributed to the writing, editing the manuscript, and review of literature; and has read and approved the final manuscript.
Conflict-of-interest statement: Dr. Sunder has nothing to disclose.
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: Thirugnanasambandan Sunder, FRCS, MBBS, MS, Academic Editor, Consultant Cardiac Surgeon, Director, Surgeon, Department of Heart Lung Transplantation and Mechanical Circulatory Support, Apollo Hospitals, Greams Lane Off Greams Road, Chennai 600086, Tamil Nadu, India. sunder64@gmail.com
Received: March 14, 2024
Revised: April 24, 2024
Accepted: May 11, 2024
Published online: July 6, 2024
Processing time: 106 Days and 15.1 Hours
Abstract

In this editorial, comments are made on an interesting article in the recent issue of the World Journal of Clinical Cases by Wang and Long. The authors describe the use of neural network model to identify risk factors for the development of intensive care unit (ICU)-acquired weakness. This condition has now become common with an increasing number of patients treated in ICUs and continues to be a source of morbidity and mortality. Despite identification of certain risk factors and corrective measures thereof, lacunae still exist in our understanding of this clinical entity. Numerous possible pathogenetic mechanisms at a molecular level have been described and these continue to be increasing. The amount of retrievable data for analysis from the ICU patients for study can be huge and enormous. Machine learning techniques to identify patterns in vast amounts of data are well known and may well provide pointers to bridge the knowledge gap in this condition. This editorial discusses the current knowledge of the condition including pathogenesis, diagnosis, risk factors, preventive measures, and therapy. Furthermore, it looks specifically at ICU acquired weakness in recipients of lung transplantation, because – unlike other solid organ transplants- muscular strength plays a vital role in the preservation and survival of the transplanted lung. Lungs differ from other solid organ transplants in that the proper function of the allograft is dependent on muscle function. Muscular weakness especially diaphragmatic weakness may lead to prolonged ventilation which has deleterious effects on the transplanted lung – ranging from ventilator associated pneumonia to bronchial anastomotic complications due to prolonged positive pressure on the anastomosis.

Keywords: Intensive care unit-acquired weakness; Critical illness myopathy; Critical illness polyneuropathy; Critical illness polyneuromyopathy; Early mobilization; Prolonged ventilation; Nutritional rehabilitation; Lung transplantation

Core Tip: Increasing number of patients are being treated in the intensive care units (ICUs) with good outcomes. However, the incidence of ICU acquired weakness (ICU-AW) is also on the rise and is a cause of significant mortality and morbidity. While certain risk factors and pathogenetic mechanisms for the development of this condition have been identified, there still exists significant lacunae in our understanding of the same. The use of artificial intelligence with artificial neural networks and machine learning techniques appears promising to provide vital information which can be used to prevent and treat ICU-AW. The impact of this condition on lung transplantation, in the setting of globally prevalent donor organ scarcity, is discussed.