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Review
. 2025 Jan 27:388:e077292.
doi: 10.1136/bmj-2023-077292.

Intensive care unit acquired weakness and physical rehabilitation in the ICU

Stephanie L Hiser  1 , Kelly Casey  2 , Peter Nydahl  3 , Carol L Hodgson  4 , Dale M Needham  5
Affiliations
Review

Intensive care unit acquired weakness and physical rehabilitation in the ICU

Stephanie L Hiser et al. BMJ. .

Abstract

Approximately half of critically ill adults experience intensive care unit acquired weakness (ICUAW). Patients who develop ICUAW may have negative outcomes, including longer duration of mechanical ventilation, greater length of stay, and worse mobility, physical functioning, quality of life, and mortality. Early physical rehabilitation interventions have potential for improving ICUAW; however, randomized trials show inconsistent findings on the efficacy of these interventions. This review summarizes the latest evidence on the definition, diagnosis, epidemiology, pathophysiology, risks factors, implications, and management of ICUAW. It specifically highlights research gaps and challenges, with considerations for future research for physical rehabilitation interventions.

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Conflict of interest statement

Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: DMN is a principal investigator on an NIH funded, multicentered randomized trial (R01HL132887) evaluating nutrition and exercise in acute respiratory failure and, related to this trial, is in receipt of an unrestricted research grant and donated amino acid product from Baxter Healthcare Corporation and an equipment loan/donation from Reck Medical Devices and EnableMe; CLH is a principal investigator on a MRFF funded, multicenter randomized trial evaluating rehabilitation in patients on ECMO (NCT05003609); she led the TEAM trial which was an international trial of early rehabilitation in ICU (https://www.nejm.org/doi/full/10.1056/NEJMoa2209083) and is funded by an NHMRC investigator grant; PN has received travel funds for lectures about early rehabilitation by professional medical societies such as German Society of Intensive and Critical Care, and German Society for Critical Care Nursing.

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