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Review
. 2022 Aug 1;28(4):409-416.
doi: 10.1097/MCC.0000000000000955. Epub 2022 Jul 5.

Poor physical recovery after critical illness: incidence, features, risk factors, pathophysiology, and evidence-based therapies

Yente Florine Niké Boelens  1   2 , Max Melchers  1   2 , Arthur Raymond Hubert van Zanten  1   2
Affiliations
Review

Poor physical recovery after critical illness: incidence, features, risk factors, pathophysiology, and evidence-based therapies

Yente Florine Niké Boelens et al. Curr Opin Crit Care. .

Abstract

Purpose of review: To summarize the incidence, features, pathogenesis, risk factors, and evidence-based therapies of prolonged intensive care unit (ICU) acquired weakness (ICU-AW). We aim to provide an updated overview on aspects of poor physical recovery following critical illness.

Recent findings: New physical problems after ICU survival, such as muscle weakness, weakened condition, and reduced exercise capacity, are the most frequently encountered limitations of patients with postintensive care syndrome. Disabilities may persist for months to years and frequently do not fully recover. Hormonal and mitochondrial disturbances, impaired muscle regeneration due to injured satellite cells and epigenetic differences may be involved in sustained ICU-AW. Although demographics and ICU treatment factors appear essential determinants for physical recovery, pre-ICU health status is also crucial. Currently, no effective treatments are available. Early mobilization in the ICU may improve physical outcomes at ICU-discharge, but there is no evidence for benefit on long-term physical recovery.

Summary: Impaired physical recovery is observed frequently among ICU survivors. The pre-ICU health status, demographic, and ICU treatment factors appear to be important determinants for physical convalescence during the post-ICU phase. The pathophysiological mechanisms involved are poorly understood, thereby resulting in exiguous evidence-based treatment strategies to date.

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Conflict of interest statement

A.R.H.V.Z. reported receiving honoraria for advisory board meetings, lectures, research, and travel expenses from AoP Pharma, Baxter, Cardinal Health, Danone-Nutricia, Dim-3, Fresenius Kabi, GE Healthcare, Mermaid, Lyric, and Rousselot. The other authors have nothing to declare.

Figures

Box 1
Box 1
no caption available
FIGURE 1
FIGURE 1
Visualized summary of study results regarding prevalence and incidence of impaired physical function following ICU-discharge in COVID-19 and non-COVID-19 patients. Legend: a Systematic review and meta-analysis including 16 studies and 1755 ICU survivors [▪▪]; b Prospective single-center study including 114 COVID-19 ICU survivors, of which 98 analyzed at 3 months, and 51 analyzed at one year [17▪]; c Prospective cohort study including 266 ≥ 70-year-old ICU-survivors [13]; d Prospective multicenter cohort study including 212 COVID-19 ICU-survivors [15▪]; e Population-based cohort study including 546 ≥ 70-year-old ICU-survivors [33]; f Prospective multicenter cohort study including 2345 adult ICU-survivors [▪▪]; g Prospective multicenter cohort study including 301 COVID-19 ICU survivors, of which 246 analyzed at one year [▪▪]; h Single-center cohort study including 149 ICU-survivors [10▪]; i Single-center cohort study including 109 ARDS ICU-survivors, of which 94 were analyzed at 5 years [11]. 6MWD, Six Minute Walking Distance; ADL, Activities of Daily Living; COVID-19, Coronavirus Disease 2019; ICU, intensive care unit; ICU-AW, ICU-acquired weakness; m6MWD, Mean Six Minute Walking Distance; mHGS, mean Hand Grip Strength. Created with BioRender.com.
FIGURE 2
FIGURE 2
Heading: Pathophysiologic mechanisms possibly involved in developing acute muscle wasting and dysfunction during critical illness, resulting in ICU-acquired weakness. ATP, adenosine triphosphate; O2, oxygen. Created with BioRender.com.
FIGURE 3
FIGURE 3
Heading: Pathophysiologic mechanisms possibly involved in prolonged muscle dysfunction following critical illness. ATP, adenosine triphosphate; HIC1, Hypermethylated in Cancer 1; NADK 2, Nicotinamide-adenine-dinucleotide Kinase 2; O2, oxygen; PICS, postintensive care syndrome. Created with BioRender.com.
See this image and copyright information in PMC

References

    1. Wischmeyer PE, San-Millan I. Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology. Crit Care 2015; 19: (Suppl 3): S6. - PMC - PubMed
    1. Needham DM, Davidson J, Cohen H, et al. . Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med 2012; 40:502–509. - PubMed
    1. Intiso D, Centra AM, Bartolo M, et al. . Recovery and long term functional outcome in people with critical illness polyneuropathy and myopathy: a scoping review. BMC Neurol 2022; 22:50. - PMC - PubMed

    2. Recently published systematic review and meta-analysis reporting the incidence of ICU-AW following ICU admission, differentiating between different ICU-AW manifestations such as CIM, CIP and the combination.

    1. Geense WW, Zegers M, Peters MAA, et al. . New physical, mental, and cognitive problems 1 year after ICU admission: a prospective multicenter study. Am J Respir Crit Care Med 2021; 203:1512–1521. - PubMed

    2. A large, Dutch multicenter study providing interesting insights into the incidence of PICS-related problems one year after ICU survival. This study adjusted for pre-ICU health status, providing a valid picture of the impact of critical illness on problems following ICU-admission.

    1. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med 2014; 371:287–288. - PubMed

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